Correlation Between Frailty and Perioperative Outcomes

Authors

  • Diana Rodrigues Departamento de Anestesiologia, Centro Hospitalar Universitário de São João, Porto, Portugal.
  • Manuel Teixeira Almeida Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  • Joselina Barbosa Departamento de Ciências da Saúde Pública e Forenses e Educação Médica. Unidade de Investigação e Desenvolvimento Cardiovascular, Centro Hospitalar Universitário de São João, Porto, Portugal.
  • Joana Mourão Departamento de Anestesiologia, Centro Hospitalar Universitário de São João, Porto, Portugal. / Departamento de Anestesiologia e Medicina Perioperatória, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

DOI:

https://doi.org/10.25751/rspa.17525

Keywords:

Frailty; Geriatric Assessment; Perioperative Care; Postoperative Complications

Abstract

Introduction: Aging of the population is associated with an increase of people with frailty proposed for elective surgery, which implies an adequate perioperative management of these patients. The goal of this study was to verify the existence of a correlation between frailty and postoperative outcomes, including hospitalization length, hospital readmission, reoperation rate, postoperative complications and mortality.
Material and Methods: We performed an observational prospective study including 100 patients proposed for elective surgery in a University Hospital. Frailty was defined as a score ≥ 6 on the Tilburg Frailty Indicator scale, in the portuguese validated version. Student's t-test and Fisher's exact test were used for comparison.
Results: The prevalence of frailty in our study was 69%. There was an association between frailty and higher age (p = 0.02), female gender (p= 0.032), and higher ASA-PS score (p = 0.013). Patients with frailty had
longer hospitalizations (p = 0.007) and a higher hospital readmission rate (p = 0.028). We did not find differences in the variables surgical risk, type of anaesthesia, duration of surgery, Charlson Comorbidity
Index, Lee Revised Cardiac Risk Index, presence of complications and mortality.
Discussion: The prevalence of frailty was higher than that described in the literature, possibly because we included only patients proposed for surgery. The main limitation of the study is patients' heterogeneity
regarding the surgery performed.
Conclusion: In this study, we found an association between frailty and a longer duration of hospitalization and hospital readmission rate. Frailty demonstrated to be a good predictor of perioperative morbidity.

Downloads

Download data is not yet available.

References

1. World Health Organization [homepage na internet]. Global Strategy and action plan on ageing and health 2017. [consultado 2019 mai 30]. Disponível em: https://www.who.int/ageing/WHO-GSAP-2017.pdf?ua=1.
2. Kanonidou Z, Karystianou G. Anesthesia for the elderly. Hippokratia. 2007;11:175–7.
3. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60:1487–92. doi: 10.1111/j.1532-5415.2012.04054.x.
4. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14:392–7. doi: 10.1016/j.jamda.2013.03.022.
5. James LA, Levin MA, Lin HM, Deiner SG. Association of preoperative frailty with intraoperative hemodynamic instability and postoperative mortality. Anesth Analg. 2019;128:1279–85. doi: 10.1213/ANE.0000000000004085.
6. Gobbens RJ, Schols JM, van Assen MA. Exploring the efficiency of the Tilburg Frailty Indicator: a review. Clin Interv Aging. 2017;12:1739-52. doi: 10.2147/CIA.S130686.
7. Coelho T, Santos R, Paúl C, Gobbens RJ, Fernandes L. Portuguese version of the Tilburg Frailty Indicator: Transcultural adaptation and psychometric validation. Geriatr Gerontol Int. 2015;15:951–60. doi: 10.1111/ggi.12373.
8. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35:2383-431. doi: 10.1093/eurheartj/ehu282.
9. Doyle DJ, Garmon EH. American Society of Anesthesiologists Classification (ASA Class) [e-book]. Treasure Island (FL): StatPearls Publishing; 2019 [consultado 2019 fev 8]. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK441940/.
10. MDCalc.com [homepage na internet]. Charlson Comorbidity Index Calculator; c2005-19 [consultado 2018 jul 8]. Disponível em: http://www.mdcalc.com/charlson-comorbidity-index-cci.
11. MDCalc.com [homepage na Internet]. Lee Revised Cardiac Risk Index Calculator; c2005-19 [consultado 2018 jul 8]. Disponível em: http://www.mdcalc.com/revised-cardiac -risk-index-pre-operative-risk.
12. Roshanov PS, Walsh M, Devereaux PJ, Danielle MS, Ngan NL, Ainslie MH, et al. External validation of the Revised Cardiac Risk Index and update of its renal variable to predict 30-day risk of major cardiac complications after noncardiac surgery: rationale and plan for analyses of the VISION study. BMJ Open 2017;7:e013510. doi: 10.1136/bmjopen-2016-013510.
13. Gobbens RJ, van Assen MA, Luijkx KG, Wijnen-Sponselee MT, Schols JM. The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc. 2010;11:344-55. doi: 10.1016/j.jamda.2009.11.003.
14. Santiago LM, Luz LL, Mattos IE, Gobbens RJ, van Assen MA. Psychometric properties of the Brazilian version of the Tilburg frailty indicator (TFI). Arch Gerontol Geriatr. 2013;57:39–45. doi: 10.1016/j.archger.2013.03.001
15. Chan SP, Ip KY, Irwin MG. Peri-operative optimisation of elderly and frail patients: a narrative review. Anaesthesia. 2019;74:80-9. doi: 10.1111/anae.14512.
16. Zhang Q, Guo H, Gu H, Zhao X. Gender-associated factors for frailty and their impact on hospitalization and mortality among community-dwelling older adults: a cross-sectional population-based study. PeerJ. 2018;6:e4326. doi: 10.7717/peerj.4326. doi: 10.7717/peerj.4326.
17. Gordon EH, Peel NM, Samanta M, Theou O, Howlett SE, Hubbard RE. Sex differences in frailty: A systematic review and meta-analysis. Exp Gerontol. 2017;89:30-40. doi: 10.1016/j.exger.2016.12.021.
18. Syddall H, Roberts HC, Evandrou M, Cooper C, Bergman H, Sayer AA. Prevalence and correlates of frailty among community-dwelling older men and women: findings from the Hertfordshire Cohort Study. Age Ageing. 2010;39:197-203. doi: 10.1093/ageing/afp204.
19. Ambler GK, Brooks DE, Al Zuhir N, Ali A, Gohel MS, Hayes PD, et al. Effect of frailty on short- and mid-term outcomes in vascular surgical patients. Br J Surg. 2015;102:638–45. doi: 10.1002/bjs.9785.
20. Kahlon S, Pederson J, Majumdar SR, Belga S, Lau D, Fradette M, et al. Association between frailty and 30-day outcomes after discharge from hospital. CMAJ. 2015;187:799-804. doi: 10.1503/cmaj.150100.
21. Zhang Y, Yuan M, Gong M, Tse G, Li G, Liu T. Failure: a systematic review and meta-analysis. J Am Med Dir Assoc. 2018;19:1003-8. doi: 10.1016/j.jamda.2018.06.009.
22. Choe YR, Joh JY, Kim YP. Association between frailty and readmission within one year after gastrectomy in older patients with gastric cancer. J Geriatr Oncol. 2017;8:185-9. doi.org/10.1016/j.jgo.2017.02.002.
23. Grossman R, Mukherjee D, Chang DC, Bennett R, Brem H, Olivi A, et al. Preoperative Charlson comorbidity score predicts postoperative outcomes among older intracranial meningioma patients. World Neurosurg. 2011;75:279–85. doi: 10.1016/j.wneu.2010.09.003.
24. Birim O, Kappetein AP, Bogers AJ. Charlson comorbidity index as a predictor of long term outcome after surgery for non-small cell lung cancer. Eur J Cardiothoracic Surg. 2005;28:759–62. doi.org/10.1016/j.ejcts.2005.06.046.
25. Ackland GL, Harris S, Ziabari Y, Grocott M, Mythen M. Revised cardiac risk index and postoperative morbidity after elective orthopaedic surgery: a prospective cohort study. Br J Anaesth. 2010;105:744-52. doi: 10.1093/bja/aeq245.
26. Hewitt J, Moug SJ, Middleton M, Chakrabarti M, Stechman MJ, McCarthy K. Prevalence of frailty and its association with mortality in general surgery. Am J Surg. 2015;209:254-9. doi: 10.1016/j.amjsurg.2014.05.022.
27. Akyar S, Armenia SJ, Ratnani P, Merchant AM. The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population. Surg J NY. 2018;4:e66-e77. doi: 10.1055/s-0038-1655756.

Published

2019-06-13

How to Cite

Rodrigues, D., Almeida, M. T., Barbosa, J., & Mourão, J. (2019). Correlation Between Frailty and Perioperative Outcomes. Journal of the Portuguese Society of Anesthesiology, 28(2), 96–101. https://doi.org/10.25751/rspa.17525

Most read articles by the same author(s)

<< < 1 2