1. Intermediately frail or frail patients, as determined by the Hopkins Frailty Score, had more post-op complications.
2. Some frailty-related predictors of complications may be modifiable and optimized before surgery.
Evidence Rating Level: 2 (Good)
Study Rundown: The decision to perform a surgical procedure on a frail patient involves balancing the indications and the risks, as even relatively minor complications can be disastrous in this population. Frailty was introduced as a global measure of physiologic reserve, defined as differential vulnerability and the ability to respond to stressors. The Hopkins Frailty Score is a commonly used tool for pre-op assessment of frailty. In addition to this score, the authors examined other measurements of frailty such as biochemical markers and self-assessments. They found the Hopkins Frailty Score to be the best predictor of post-op complications of the parameters examined. As such, they did not offer an augmentation of it. Despite the limitation of patient numbers, with only seven patients in the frail category, this study attempts to include frail patients of all ages over 18. While this is an interesting and noble goal, frailty in younger adults may be more appropriately analyzed separately from the common troubles of the elderly, particularly due to the difference in the surgeries performed. Nevertheless, this study reinforces the utility of the Hopkins Frailty Score for the preoperative assessment of patient frailty.
Click to read the study in the Journal of the American College of Surgeons
Relevant Reading: Redefining geriatric preoperative assessment using frailty, disability and co-morbidity
In-Depth [prospective cohort]: This study analyzed data from 189 patients enrolled after surgical consultation and before surgery, at Emory University. Patients were assessed by the Hopkins Frailty Score (based on shrinking, weakness, exhaustion, low activity, and slowed walking speed), traditional risk indices used by surgeons and anesthesiologists, the Charlson Comorbidity Index, common pre-op biochemical markers (albumin, CRP, eGFR, Hg). In addition, they were given questionnaires assessing activities of daily living (ADLs), mental health, and nutrition. The majority of patients were male and Caucasian. The most common operations were oncological: GI procedures, nephrectomies, and cystectomies with urinary diversion. 43 (22.8%) patients were intermediately frail, 7 (3.7%) were frail. 73 (38.6%) patients had post-op complications, mostly Grade I/II. On univariate analysis, the Hopkins Frailty Score (OR 2.07, CI 1.05-4.08) as well as its subscores were significant predictors of complication; most other evaluative methods were not. Pre-op hemoglobin (OR 0.835, CI 0.71-0.99) and presence of weight loss (OR 1.78, CI 0.94-3.40) were significant predictors on univariate analysis.
By Mariya Samoylova and Chaz Carrier
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