Frailty scores alone may be poor predictors of intensive care admission or hospital stay duration

1. Frailty scores alone (mFI-5, CCI) are poor predictors of intensive care unit (ICU) admission or prolonged hospital stay in elderly patients undergoing diverse elective surgeries

Evidence Rating Level: 3 (Average)

This single-center retrospective study evaluated the predictive value of the Modified Frailty Index (mFI-5) and Charlson Comorbidity Index (CCI) for critical care admission and hospital length of stay (LoS) in elderly patients undergoing non-cardiac surgery. Conducted at the Mater Misericordiae University Hospital in Dublin, the study included 100 patients aged >65 who attended the preoperative clinic between November and December 2023. The mFI-5 and CCI scores were calculated for each patient, and their ability to predict critical care needs and extended LoS (>5 days) was assessed using AUROC analysis. The results showed that neither score effectively predicted critical care admission (AUROC: mFI-5 = 0.52, CCI = 0.53) or extended hospital stay (AUROC: mFI-5 = 0.62, CCI = 0.59). Despite frailty being a known risk factor for adverse postoperative outcomes, these indices alone failed to provide sufficient predictive power in a diverse surgical population. The authors suggest this may be due to the heterogeneity of procedures and the elective nature of the surgeries, where preoperative clinician judgment and conservative management may confound objective risk models. The study concludes that mFI-5 and CCI, while useful in specific surgical contexts, are insufficient as standalone tools for predicting postoperative resource needs in general elderly surgical populations. Future risk stratification models should integrate frailty scores with surgery- and anesthesia-specific variables to enhance perioperative planning and optimize resource allocation.

Click to read the study in PLOSONE

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