The association of peri‐operative scores, including frailty, with outcomes after unscheduled surgery

Abstract

Postoperative hospital stay is longer for frail, older patients, who are more likely to experience prolonged postoperative morbidity and reduced long-term survival. We recorded in-hospital mortality, morbidity and length of stay for 164 patients aged at least 65 years after unscheduled surgery. We evaluated pre-operative frailty with the 7-point Clinical Frailty Scale: 81 patients were 'not vulnerable' (frailty score 1-3) and 83 were 'vulnerable or frail' (frailty score ≧ 4), with mean (SD) ages of 74.7 (7.5) years vs. 79.4 (8.3) years, respectively, p < 0.001. Within 30 postoperative days 8/164 (5%) patients died, all with frailty scores ≧ 4, p = 0.007. Postoperative morbidity was less frequent in patients categorised as 'not vulnerable' on four out of the six days it was measured (days 3, 5, 8, 14, 23, 28). Median (IQR [range]) postoperative stay was 9 (6-18 [2-221]) days for patients with frailty scores 1-3, and 22 (12-33 [2-270]) days for patients with score ≧ 4, p < 0.001. Four variables independently associated with hospital discharge, hazard ratio (95%CI): E-POSSUM, 0.74 (0.60-0.92), p = 0.007; ASA 2, 0.35 (0.13-0.98), p = 0.046, ASA 3, 0.17 (0.06-0.47), p = 0.001 and ASA 4/5, 0.08 (0.02-0.28), p < 0.001; operative severity 'major +', 0.69 (0.41-1.08), p = 0.10 and the Surgical Outcome Risk Tool, 7.75 (0.81-74.40), p = 0.08.

A review of ASA physical status – historical perspectives and modern developments

“…There is increasing interest in the concept of frailty. Various measures of frailty correlate with various outcomes, including postoperative morbidity and mortality, intensive care survival and postdischarge status . There is some evidence that specialist frailty assessment and treatment teams might alter outcomes .…”

Physiological and operative severity score for the enumeration of mortality and morbidity, frailty, and perioperative quality of life in the elderly

“…To our knowledge, this correlation has not been yet described in the literature, although there have been some reports on the association between frailty and postoperative morbidity. [ 21 22 ]…”

Preoperative Evaluation of the Frail Patient

“…In terms of frailty tool-specific findings, frailty status as defined by the DAI, Groningen Frailty Indicator (GFI), VES, and Clinical Frailty Scale (CFS) was associated with higher rates of postoperative complications in patients undergoing emergency surgery 35,36,43,44 ; however, this was not observed with the Brief Frailty Instrument. 35 Interestingly, the VES and GFI were used alongside the Brief Frailty Instrument in the same surgical population to categorize frailty status.…”