Clinical Utility of Frailty Scales for the Prediction of Postoperative Complications: Systematic Review and Meta-Analysis.

INTRODUCTION Frailty can be defined as a biological syndrome of reduced reserve and resistance to stressful events. Evidence suggests that this syndrome is linked to adverse outcomes in various surgical populations. Several instruments have been developed to measure frailty, however there is no consensus about which one is the most useful in the surgical population. Therefore, this study aims to evaluate the utility of different frailty scales in the prediction of postoperative complications in older surgical population. METHODS This review and meta-analysis assembles prospective cohort studies reporting frailty and postoperative outcomes. Searches were performed in PubMed/Medline, Scielo, Cochrane Library and ScienceDirect databases. Statistical analyses was performed using Review Manager software and the pooled Odds Rattios was calculated. RESULTS A total of 15 articles were included in the present review. Frailty was significantly associated with postoperative complications (OR=2.53, 95% CI: 2.07-3.10; p<0.00001), mortality until 30 days (OR=3.49, 95% CI: 2.40-5.09, p<0.00001) and higher 1-year mortality (OR= 2.90, 95% CI: 1.99-4.24, p<0.00001), and with hospital length of stay >5days or >14days (OR=2.78, 95% CI: 1.45-5.30, p=0.002 and OR=2.40 (95% CI: 1.08-5.36, p= 0.03, respectively). In addition, our meta-analysis showed that frailty is a significant predictor of renal failure (OR=5.03, 95% CI: 1.74-14.54, p=0.003), neurological complications (OR= 3.41, 95% CI: 1.08-10.73, p=0.04), respiratory complications (OR=9.21 (95% CI: 2.35- 36.02, p=0.001), wound infection (OR=2.85 (95% CI: 1.65-4.94, p=0.0002) and sepsis (OR=3.84 (95% CI: 1.37-10.71, p=0.01). CONCLUSION Overall, frailty significantly increases the risk for developing adverse outcomes after surgery, so early detection of frailty may be a window of opportunity for intervention and a key factor for improving clinical outcomes. Moreover, future studies are required for the standardization of the frailty scales used.

[1]  M. Yassuda,et al.  Screening for Frailty With the FRAIL Scale: A Comparison With the Phenotype Criteria. , 2017, Journal of the American Medical Directors Association.

[2]  D. Beckwée,et al.  Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. , 2016, Journal of the American Medical Directors Association.

[3]  L. Ngo,et al.  Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery , 2016, Journal of the American Geriatrics Society.

[4]  R. Audisio.  Preoperative evaluation of the older patient with cancer. , 2016, Journal of geriatric oncology.

[5]  H. Wildiers,et al.  The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: A systematic review. , 2016, Journal of geriatric oncology.

[6]  P. Macdonald,et al.  Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation. , 2016, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[7]  S. Bagshaw,et al.  Assessment and Utility of Frailty Measures in Critical Illness, Cardiology, and Cardiac Surgery. , 2016, The Canadian journal of cardiology.

[8]  L. Lipsitz,et al.  Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures , 2016, Annals of Internal Medicine.

[9]  K. Ogan,et al.  Frailty and one-year mortality in major intra-abdominal operations. , 2016, The Journal of surgical research.

[10]  W. Lim,et al.  The clinical frailty scale predicts functional decline and mortality when used by junior medical staff: a prospective cohort study , 2016, BMC Geriatrics.

[11]  C. van Walraven,et al.  Association of Frailty and 1-Year Postoperative Mortality Following Major Elective Noncardiac Surgery: A Population-Based Cohort Study. , 2016, JAMA surgery.

[12]  Manuel Montero-Odasso,et al.  Clinical Frailty Scale in an Acute Medicine Unit: a Simple Tool That Predicts Length of Stay , 2016, Canadian geriatrics journal : CGJ.

[13]  Luke P Brewster,et al.  Frailty increases the risk of 30-day mortality, morbidity, and failure to rescue after elective abdominal aortic aneurysm repair independent of age and comorbidities. , 2015, Journal of vascular surgery.

[14]  J. Hewitt,et al.  Prevalence of frailty and its association with mortality in general surgery. , 2015, American journal of surgery.

[15]  Jeremiah T. Martin,et al.  Identification of patients with postoperative complications who are at risk for failure to rescue. , 2014, JAMA surgery.

[16]  V. Periyakoil,et al.  Understanding Frailty in Cancer Patients , 2014, Cancer journal.

[17]  R. Audisio,et al.  Surgical considerations in older adults with cancer. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  P. Rhee,et al.  Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. , 2014, JAMA surgery.

[19]  Ho-Seong Han,et al.  Multidimensional frailty score for the prediction of postoperative mortality risk. , 2014, JAMA surgery.

[20]  E. Finlayson,et al.  Preoperative assessment of the older patient: a narrative review. , 2014, JAMA.

[21]  P. Rhee,et al.  Frailty in surgery , 2014, The journal of trauma and acute care surgery.

[22]  Daniel E Forman,et al.  Frailty assessment in the cardiovascular care of older adults. , 2014, Journal of the American College of Cardiology.

[23]  S. Bagshaw,et al.  Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study , 2014, Canadian Medical Association Journal.

[24]  J. Stoot,et al.  Value of Geriatric Frailty and Nutritional Status Assessment in Predicting Postoperative Mortality in Gastric Cancer Surgery , 2014, Journal of Gastrointestinal Surgery.

[25]  Marc Moss,et al.  Simple frailty score predicts postoperative complications across surgical specialties. , 2013, American journal of surgery.

[26]  P. Pibarot,et al.  Prognostic value of exercise capacity as evaluated by the 6-minute walk test in patients undergoing transcatheter aortic valve implantation. , 2013, Journal of the American College of Cardiology.

[27]  S. Patten,et al.  Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living , 2012, BMC Geriatrics.

[28]  Larry Z. Slater,et al.  The Impact of Inflammation on Cognitive Function in Older Adults: Implications for Healthcare Practice and Research , 2012, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[29]  H. Boter,et al.  Prevalence of Frailty in Community‐Dwelling Older Persons: A Systematic Review , 2012, Journal of the American Geriatrics Society.

[30]  J. Woo,et al.  Comparison of Frailty Indicators Based on Clinical Phenotype and the Multiple Deficit Approach in Predicting Mortality and Physical Limitation , 2012, Journal of the American Geriatrics Society.

[31]  Terence Tang,et al.  Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. , 2012, American journal of surgery.

[32]  K. Alexander,et al.  Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity , 2012, Circulation. Cardiovascular quality and outcomes.

[33]  T. Robinson,et al.  Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. , 2011, American journal of surgery.

[34]  Sathya Karunananthan,et al.  The Identification of Frailty: A Systematic Literature Review , 2011, Journal of the American Geriatrics Society.

[35]  Kenneth Rockwood,et al.  Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National Population Health Survey , 2011, Canadian Medical Association Journal.

[36]  Nandini Dendukuri,et al.  Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. , 2010, Journal of the American College of Cardiology.

[37]  C. Ko,et al.  Comparison of 30-day outcomes after emergency general surgery procedures: potential for targeted improvement. , 2010, Surgery.

[38]  M. Makary,et al.  Frailty as a predictor of surgical outcomes in older patients. , 2010, Journal of the American College of Surgeons.

[39]  Joanna Chikwe,et al.  Frailty: the missing element in predicting operative mortality. , 2010, Seminars in thoracic and cardiovascular surgery.

[40]  C. Cooper,et al.  Prevalence and correlates of frailty among community-dwelling older men and women: findings from the Hertfordshire Cohort Study. , 2010, Age and ageing.

[41]  G. Savva,et al.  Inflammation and frailty measures in older people , 2009, Journal of cellular and molecular medicine.

[42]  Thomas M Gill,et al.  Prognostic Significance of Potential Frailty Criteria , 2008, Journal of the American Geriatrics Society.

[43]  Jack M Guralnik,et al.  Performance-based functional assessment in older hospitalized patients: feasibility and clinical correlates. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[44]  J. Purser,et al.  Frailty Predicts Some but Not All Adverse Outcomes in Older Adults Discharged from the Emergency Department , 2008, Journal of the American Geriatrics Society.

[45]  Konstantin G Arbeev,et al.  Cumulative Deficits Better Characterize Susceptibility to Death in Elderly People than Phenotypic Frailty: Lessons from the Cardiovascular Health Study , 2008, Journal of the American Geriatrics Society.

[46]  G. Abou-Alfa,et al.  Identifying Vulnerable Older Adults with Cancer: Integrating Geriatric Assessment into Oncology Practice , 2007, Journal of the American Geriatrics Society.

[47]  K. Alexander,et al.  Identifying Frailty in Hospitalized Older Adults with Significant Coronary Artery Disease , 2006, Journal of the American Geriatrics Society.

[48]  L. Ferrucci,et al.  Phenotype of frailty: characterization in the women's health and aging studies. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[49]  R. Depalma,et al.  Determinants of Long-Term Survival After Major Surgery and the Adverse Effect of Postoperative Complications , 2005, Annals of surgery.

[50]  I. McDowell,et al.  A global clinical measure of fitness and frailty in elderly people , 2005, Canadian Medical Association Journal.

[51]  Aaron Aragaki,et al.  Frailty: Emergence and Consequences in Women Aged 65 and Older in the Women's Health Initiative Observational Study , 2005, Journal of the American Geriatrics Society.

[52]  L. Fried,et al.  Frailty in older adults: evidence for a phenotype. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[53]  E. Skovlund,et al.  A comparison of two pre-operative frailty measures in older surgical cancer patients , 2012 .

[54]  F. Mohr,et al.  Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. , 2011, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.