Too Frail for Surgery? Initial Results of a Large Multidisciplinary Prospective Study Examining Preoperative Variables Predictive of Poor Surgical Outcomes

Revenig, Louis M.; Canter, Daniel; Taylor, Maxwell D.; Tai, Caroline G.; Sweeney, John F.; Sarmiento, Juan M.; Kooby, David A.; Maithel, Shishir K.; Master, Viraj A.; Ogan, Kenneth

doi:10.1016/j.jamcollsurg.2013.06.012

Cited by 272 publications

(181 citation statements)

References 25 publications

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“…Most studies were observational (23 of 35) with a total of 1 153 684 patients available for the analysis. Cohorts were composed of patients undergoing lower gastrointestinal (GI) surgery (10 studies), upper GI surgery (6), mixed GI surgery (4), gynaecological surgery (6), urological surgery (4) and mixed abdominal surgery (6) ( Table 1)1 12, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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“…003 19 (59) 20 (46) 11 (32) 13 (41) 24 (55) 23 (68) . 09 29 (91) 32 (73) 23 (68) 3 (9) 12 (27) 11 (32) .07…”

Section: Resultsunclassified

“…Incident data and audits of admission risk, performed in my clinical role, showed similar levels of risk of falls and pressure ulcers in older medical and surgical ward patients. Pilot studies at RBWH to reduce geriatric syndromes and improve outcomes in acute medical patients had shown promising results (30)(31)(32)(33). A better understanding of the occurrence of geriatric syndromes in older surgical ward patients would inform the potential for broader applicability of these interventions with vulnerable older surgical groups.…”

Section: The Settingmentioning

confidence: 99%

“…Five of the included studies were sub-group analyses of larger studies (27)(28)(29)(30)(31). Several studies reported findings for more than one outcome (10,24,30,32,33).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…This variation was supported by the other reported studies of POD in this review. For example, the highest incidence of delirium occurred in patients undergoing abdominal surgery (24-51%) (32,(38)(39)(40) compared to those undergoing orthopaedic (10-28%) (37,(41)(42)(43)(44) or urological procedures (2-9%) (28,35).…”

Section: Deliriummentioning

confidence: 99%

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Understanding the occurrence of geriatric syndromes in older surgical patients

McRae¹

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The population is ageing and surgery is becoming more common as the treatment of choice for many diseases and conditions in older people. Although mortality rates are low for many operations, older patients are at increased risk of complications and may have poor outcomes including longer hospital stays and discharge to sub-acute care or aged care facilities.The aim of this thesis was to describe the occurrence of non-disease specific complications, known as geriatric syndromes, in older patients admitted to surgical wards, and to explore the association of 'frailty' and other key risk factors with geriatric syndromes and discharge outcomes in order to identify high risk groups who might benefit from interventions designed to prevent these complications and improve discharge outcomes.The specific aims were to:1. Describe the occurrence of geriatric syndromes in older surgical ward patients (with the exception of hip fracture or cardiothoracic patients) 2. Investigate the association between key risk factors for geriatric syndromes and discharge outcomes (acute length of stay and discharge destination) in older surgical ward patients.A literature review of the occurrence of geriatric syndromes in the broader surgical population cared for in usual care wards is presented in Chapter 2(1).The occurrence of geriatric syndromes in older patients admitted under two surgical subspecialty units is presented in Chapter 3 (2). In this retrospective cohort study of 112 patients aged 65, admitted under the urology or vascular surgical units of Royal Brisbane and Women's Hospital for three days or more, we found that geriatric syndromes occurred in 32 % of patients. We examined the association of pre-existing impairment in activities of daily living (a unidimensional marker of frailty), mode of admission (elective versus non-elective), extent of surgery (non-operative, minor, major) and surgical sub-specialty unit with ≥1 geriatric syndromes. In multivariable analysis, nonelective admission, major surgery and pre-existing impairment in activities of daily living increased the likelihood of geriatric syndromes. No significant association was seen in the adjusted model with surgical unit, age or comorbidity score.In Chapter 4, we describe the prevalence of frailty and the occurrence of geriatric syndromes in older vascular surgical ward patients and more precisely examine the association of pre-existing II patient factors (frailty and comorbidities), illness severity, surgical severity and mode of admission with ≥1 geriatric syndromes, acute length of stay and discharge destination from the vascular surgical unit. In a prospective cohort study of 110 patients admitted to the vascular surgical unit of Royal Brisbane and Women's Hospital for three days or more, we found that 39% of participants were frail and 36% developed ≥1 geriatric syndromes. In multivariable analysis, this study found multiple risk factors for geriatric syndromes; frailty and non-elective admission were important predictors for both geriatric syndrom...

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Summary of the Panel Session at the 38th Annual Surgical Symposium of the Association of VA Surgeons

et al. 2014

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Owing to the phenomenon known as "global graying," elderly-specific conditions, including frailty, will become more prominent among patients undergoing surgery. The concept of frailty, its effect on surgical outcomes, and its assessment and management were discussed during the 38th Annual Surgical Symposium of the Association of VA Surgeons panel session entitled "What's the Big Deal about Frailty?" and held in New Haven, Connecticut, on April 7, 2014. The expert panel discussed the following questions and topics: (1) Why is frailty so important? (2) How do we identify the frail patient prior to the operating room? (3) The current state of the art: preoperative frail evaluation. (4) Preoperative interventions for frailty prior to operation: do they work? (5) Intraoperative management of the frail patient: does anesthesia play a role? (6) Postoperative care of the frail patient: is rescue the issue? This special communication summarizes the panel session topics and provides highlights of the expert panel's discussions and relevant key points regarding care for the geriatric frail surgical patient.

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Too Frail for Surgery? Initial Results of a Large Multidisciplinary Prospective Study Examining Preoperative Variables Predictive of Poor Surgical Outcomes

Cited by 272 publications

References 25 publications

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Understanding the occurrence of geriatric syndromes in older surgical patients

Summary of the Panel Session at the 38th Annual Surgical Symposium of the Association of VA Surgeons

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