Warum und wie sollte ich Frailty erfassen? – ein Ansatz für die Anästhesieambulanz

Birkelbach, Oliver; Mörgeli, Rudolf; Balzer, Felix; Olbert, Maria; Treskatsch, Sascha; Kiefmann, Rainer; Müller‐Werdan, Ursula; Reißhauer, Anett; Schwedtke, Christine; Neuner, Bruno; Spies, Claudia

doi:10.1055/s-0043-104682

Cited by 11 publications

(6 citation statements)

References 34 publications

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“…In a previous article, we summarized a frailty assessment based on the Fried criteria that seems feasible in preoperative routine care and at the same time adequately describes the phenotype [17]. This study indicates that a frailty assessment is practicable in a routine setting, and is able to identify patients at higher risk for complications.…”

Section: Discussionmentioning

confidence: 88%

“…For the analysis, patients were classified into three groups according to the number of preoperative pathological frailty criteria described by Fried (0–5 criteria, see Table 1), consisting of non-frail (0 criteria, reference group), pre-frail (1–2 positive criteria), and frail (3–5 positive criteria) groups. Slight modifications were made to Fried’s frailty assessment in an attempt to adapt and improve data collection according to European standards, as summarized in a previous publication [17]. This included estimating weight loss in kilograms instead of pounds, and using a cut-off of ≥5 kg instead of ≥10 pounds (ca.…”

Section: Methodsmentioning

confidence: 99%

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Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

et al. 2019

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BackgroundFrailty is a frequent and underdiagnosed functional syndrome involving reduced physiological reserves and an increased vulnerability against stressors, with severe individual and socioeconomic consequences. A routine frailty assessment was implemented at our preoperative anaesthesia clinic to identify patients at risk.ObjectiveThis study examines the relationship between frailty status and the incidence of in-hospital postoperative complications in elderly surgical patients across several surgical disciplines.DesignRetrospective observational analysis.SettingSingle center, major tertiary care university hospital. Data collection took place between June 2016 and March 2017.PatientsPatients 65 years old or older were evaluated for frailty using Fried’s 5-point frailty assessment prior to elective non-cardiac surgery. Patients were classified into non-frail (0 criteria, reference group), pre-frail (1–2 positive criteria) and frail (3–5 positive criteria) groups.Main outcome measuresThe incidence of postoperative complications was assessed until discharge from the hospital, using the roster from the National VA Surgical Quality Improvement Program. Propensity score matching and logistic regression analysis were performed.ResultsFrom 1186 elderly patients, 46.9% were classified as pre-frail (n = 556), and 11.4% as frail (n = 135). The rate of complications were significantly higher in the pre-frail (34.7%) and frail groups (47.4%), as compared to the non-frail group (27.5%). Similarly, length of stay (non-frail: 5.0 [3.0;7.0], pre-frail: 7.0 [3.0;9.0], frail 8.0 [4.5;12.0]; p < 0.001) and discharges to care facilities (non-frail:1.6%, pre-frail: 7.4%, frail: 17.8%); p < 0.001) were significantly associated with frailty status. After propensity score matching and logistic regression analysis, the risk for developing postoperative complications was approximately two-fold for pre-frail (OR 1.78; 95% CI 1.04–3.05) and frail (OR 2.08; 95% CI 1.21–3.60) patients.ConclusionsThe preoperative frailty assessment of elderly patients identified pre-frail and frail subgroups to have the highest rate of postoperative complications, regardless of age, surgical discipline, and surgical risk. Significantly increased length of hospitalisation and discharges to care facilities were also observed. Implementation of routine frailty assessments appear to be an effective tool in identifying patients with increased risk. Now future studies are needed to investigate whether patients benefit from optimization of patient counselling, process planning, and risk reduction protocols based on the application of risk stratification.

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Section: Discussionmentioning

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

et al. 2019

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“…Erst durch diese Miterfassung der funktionellen Einschränkungen können perspektivisch Aussagen zur Notwendigkeit von Transferleistungen unter gesundheitsökonomischen Aspekten getroffen werden. Alternativ oder in Ergänzung zu den klassischen geriatrischen Skalen findet der Frailty-Phänotyp [15,16] [17]. Ihre Umsetzung in der klinischen Versorgung der Patienten ist dringend notwendig, um das optimale Behandlungsergebnis zu erzielen und zahlreiche postoperative Komplikationen zu vermeiden.…”

Section: Die Rolle Vorbestehender Kognitiver Störungenunclassified

“…Ein solches Screening hat sich nicht nur als praktikabel erwiesen, sondern auch gezeigt, dass der Anteil von Patienten mit bereits bestehender kognitiver Einschränkung beachtlich ist [22]. Wir empfehlen das präoperative kognitive Screening als Bestandteil eines fokussierten geriatrischen Assessments, wie bereits durch Birkelbach et al vorbeschrieben [15].…”

Section: Merkeunclassified

Empfehlungen zur Erfassung und Beschreibung perioperativer kognitiver Störungen in Wissenschaft und Praxis

Borchers¹,

Knaak²,

Piper³

et al. 2019

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungPerioperative kognitive Störungen treten bei über 70-jährigen Patienten häufig auf und führen zu einer reduzierten Lebensqualität. Dieser Beitrag stellt die 2018 publizierten Nomenklaturempfehlungen der Nomenclature Consensus Working Group vor, durch die perioperative kognitive Störungen erstmals exakt erfasst und beschrieben werden können. Dies ermöglicht ein gezieltes Screening und das frühzeitige Erkennen betroffener Patienten.

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“…Furthermore, frailty leads to a higher fall risk [ 12 ] and higher levels of fear of falling [ 13 ], both of whom are known to lead to a further decline in physical activity [ 14 ]. Additionally, frailty is associated with an increased risk of post-surgical complications [ 15 , 16 ], and overall mortality [ 17 ]. However, current evidence suggests that increasing physical activity (PA) can reverse frailty [ 18 ], a decline in physiological performance [ 18 ], and contributes to the prevention of falls [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Validation of a Laser Ranged Scanner-Based Detection of Spatio-Temporal Gait Parameters Using the aTUG Chair

Fudickar

Kiselev

Stolle

et al. 2021

Sensors

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This article covers the suitability to measure gait-parameters via a Laser Range Scanner (LRS) that was placed below a chair during the walking phase of the Timed Up&Go Test in a cohort of 92 older adults (mean age 73.5). The results of our study demonstrated a high concordance of gait measurements using a LRS in comparison to the reference GAITRite walkway. Most of aTUG’s gait parameters demonstrate a strong correlation coefficient with the GAITRite,indicating high measurement accuracy for the spatial gait parameters. Measurements of velocity had a correlation coefficient of 99%, which can be interpreted as an excellent measurement accuracy. Cadence showed a slightly lower correlation coefficient of 96%, which is still an exceptionally good result, while step length demonstrated a correlation coefficient of 98% per leg and stride length with an accuracy of 99% per leg. In addition to confirming the technical validation of the aTUG regarding its ability to measure gait parameters, we compared results from the GAITRite and the aTUG for several parameters (cadence, velocity, and step length) with results from the Berg Balance Scale (BBS) and the Activities-Specific Balance Confidence-(ABC)-Scale assessments. With confidence coefficients for BBS and velocity, cadence and step length ranging from 0.595 to 0.798 and for ABC ranging from 0.395 to 0.541, both scales demonstrated only a medium-sized correlation. Thus, we found an association of better walking ability (represented by the measured gait parameters) with better balance (BBC) and balance confidence (ABC) overall scores via linear regression. This results from the fact that the BBS incorporates both static and dynamic balance measures and thus, only partly reflects functional requirements for walking. For the ABC score, this effect was even more pronounced. As this is to our best knowledge the first evaluation of the association between gait parameters and these balance scores, we will further investigate this phenomenon and aim to integrate further measures into the aTUG to achieve an increased sensitivity for balance ability.

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Warum und wie sollte ich Frailty erfassen? – ein Ansatz für die Anästhesieambulanz

Cited by 11 publications

References 34 publications

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

Empfehlungen zur Erfassung und Beschreibung perioperativer kognitiver Störungen in Wissenschaft und Praxis

Validation of a Laser Ranged Scanner-Based Detection of Spatio-Temporal Gait Parameters Using the aTUG Chair

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