Frailty Largely Impacts Surgery Outcomes

Preoperative frailty may be a significant risk factor in operative patients across subspecialties, according to a recent study.

“Frailty is an emerging risk factor for surgical outcomes, however its application across large populations is not well defined,” the study authors wrote.

To study its impact, researchers prospectively measured frailty in elective surgery patients from a single health care system comprised of four hospitals between January 2016 and June 2017. Using the modified Hopkins score to measure frailty, patients were classified as low (0), intermediate (1-2), or high (3-5), and operations were classified as inpatient or outpatient. Thirty-day major morbidity, discharge location, emergency department visit, readmission, length of stay, mortality, and direct-cost/patient.

Frailty matters. https://t.co/GMP6O58FZr

— Timothy A Mixon MD (@stemiusa) March 5, 2019

Frailty Affects Outcomes Across Surgeries

A total of 14,530 elective surgery patients (68.1% outpatient, 31.9% inpatient) were included; surgery classifications were: general, 29%; urology, 24%; plastic surgery, 13%; otolaryngology, 8%; podiatry, 6%; surgical oncology, 5%; cardiothoracic, 4%; colorectal, 4%; transplant, 3%; oral maxillofacial, 2%; and vascular, 2%. Overall, 3.4% of patients were classified as high frailty (5.3% inpatient, 2.5% outpatient. Across all patients, major morbidity, readmission, and mortality incidence rates were correlated with frailty classification (P < 0.05). Among the inpatient group, higher frailty classification increased the risk for length of stay (low, 1.6 days; intermediate, 2.3 days; high 4.1 days; P < 0.001) and discharge to facility (P < 0.05). In the outpatient cohort, emergency department visit increased with frailty (P < 0.05). Direct-cost also increased with frailty (low, $7,045; intermediate, $7,995; high, $8,599; P < 0.05).

A large study evaluating frailty and outcomes in elective surgery from @bswhealth

Great work from @claire_isbell @erintbird and members of our Surgery Department! #populationhealthforsurgeons? https://t.co/Dg07sjhwey

— Papaconstantinou, MD (@htpapaco) March 4, 2019

Frailty affected patients across age groups, the study authors noted.

“Frailty is identified as an important risk factor affecting surgical outcomes in elderly patients and more recently also in younger patients, even people as young as 40,” said lead study author Claire L. Isbell, MD, MSCI, FACS, a general surgeon at Baylor Scott & White Memorial Hospital in Temple, Texas, in a press release. “With the national obesity epidemic, comorbidities typically seen later in life are increasingly prevalent in younger people.”

According to co-author Harry T. Papaconstantinou, MD, FACS, chairman of the department of surgery at Baylor Scott & White Memorial Hospital, this study was the first to measure frailty’s effect in outcomes across subspecialties for inpatient and outpatient cohorts.

#prehabilitation has all it importance while preparing major surgery: You would train for a marathon. Similarly, you have to get ready for an operation so you have the least possible risk of negative outcomes. https://t.co/la4VIOBz23

— Ihsan INAN, MD FMH FACS (@InanMD) March 3, 2019

The study’s findings demonstrate that patients should have conversations with their doctors prior to undergoing surgery, Papaconstantinou said.

“We think patients should discuss their frailty risk with their surgeon and the ways they can improve their health before their operation,” he shared in a press release. “You would train for a marathon. Similarly, you have to get ready for an operation so you have the least possible risk of negative outcomes.”