A Comparison of Two Preoperative Frailty Models in Predicting Postoperative Outcomes in Geriatric General Surgical Patients

Andreou, Alexandros; Lasithiotakis, Konstantinos; Venianaki, Maria; Xenaki, Sofia; Chlouverakis, Gregorios; Petrakis, Ioannis; Chalkiadakis, George

doi:10.1007/s00268-018-4734-3

Cited by 14 publications

(12 citation statements)

References 46 publications

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“…Moreover, the functional independence and the comorbidities of the patients are outweighed by ASA physical status which largely includes those elements by definition. Finally, it was not appropriate to use standardized frailty definitions in our analyses because in the frailty definitions that we have published in the past, malnutrition risk is a defining factor [30,31]. Instead, we used measures of functional capacity and comorbidity which do not include malnutrition indices.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Malnutrition and Its Impact on Postoperative Outcomes in Older Patients

Venianaki

Andreou

Νikolouzakis

et al. 2021

JCM

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Malnutrition is associated with dismal treatment outcomes in older patients but its impact in geriatric surgery has not been studied extensively. Herein, we report the prevalence of malnutrition risk, its risk factors and its association with postoperative outcomes in older patients undergoing operations of general surgery. This is a retrospective analysis of a prospectively maintained database including patients older than 65 years who were to undergo general surgery operations between 2012 and 2017. The Malnutrition Universal Screening Tool (MUST) was used for nutritional risk. Demographics, socioeconomic data, site and magnitude of the operation, various measures of comorbidity and functional dependence as well as postoperative complications based on Clavien–Dindo classification and length of stay were recorded. There were 501 patients. A total of 28.6% of them were at intermediate malnutrition risk (MUST = 1) and 14.6% were at high malnutrition risk (MUST ≥ 2). Variables independently associated with malnutrition risk (MUST ≥ 1) were smoking (Odds Ratio, OR:1.6, p = 0.041), upper gastrointestinal (GI) tract surgery (OR:20.4, p < 0.001), hepatobiliary-pancreatic surgery (OR:3.7, p = 0.001), lower GI surgery (OR:5.2, p < 0.001) and American Society of Anesthesiologists (ASA) class III/IV (OR:2.8, p = 0.001). In the multiple regression analysis adjusted for several confounding variables, the MUST score was significantly associated with postoperative death (OR:9.1, p = 0.047 for MUST = 1 and OR:11.9, p = 0.035 for MUST score ≥ 2) and postoperative hospital stay (adjusted incidence rate ratio, 1.3, p = 0.041 for MUST = 1 and 1.7, p < 0.001 for MUST ≥ 2). Malnutrition risk was highly prevalent in this sample, particularly in patients with operations of the gastrointestinal tract, in patients with poor physical status and it was associated with postoperative mortality and length of stay.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with Malnutrition and Its Impact on Postoperative Outcomes in Older Patients

Venianaki

Andreou

Νikolouzakis

et al. 2021

JCM

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“…59,68 Complications Fifty studies reported outcome data for postoperative complications (total n = 31,408; Supplemental Digital Content, table 3, http://links.lww.com/ALN/C333). [30][31][32][33][34][36][37][38][39][41][42][43][45][46][47][48]51,[53][54][55][56]58,60,63,64,66,69,71,[73][74][75][76][80][81][82]84,86,88,89,91,[94][95][96][97][98][99][100][101] Eight studies reported postoperative complication data for ...…”

Section: Accuracy and Feasibility Of Frailty Instrumentsmentioning

confidence: 99%

“…Thirty-two studies reported aspects of feasibility. 6,39,46,55,56,60,[63][64][65]67,68,70,[76][77][78][82][83][84]86,92,93 Findings are summarized in table 3 (full details in Supplemental Digital Content, table 8, http://links.lww.com/ALN/C333); only 19 of 50 available data points were based on objective data, compared to 31 of 50 that were subjectively supported. Overall, the Clinical Frailty Scale, Edmonton Frail Scale, Frailty Index, and Fried Phenotype had the largest amounts of available data.…”

Section: Feasibilitymentioning

confidence: 99%

Accuracy and Feasibility of Clinically Applied Frailty Instruments before Surgery

Aucoin¹,

Hao²,

Sohi³

et al. 2020

Anesthesiology

158

171

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Background A barrier to routine preoperative frailty assessment is the large number of frailty instruments described. Previous systematic reviews estimate the association of frailty with outcomes, but none have evaluated outcomes at the individual instrument level or specific to clinical assessment of frailty, which must combine accuracy with feasibility to support clinical practice. Methods The authors conducted a preregistered systematic review (CRD42019107551) of studies prospectively applying a frailty instrument in a clinical setting before surgery. Medline, Excerpta Medica Database, Cochrane Library and the Comprehensive Index to Nursing and Allied Health Literature, and Cochrane databases were searched using a peer-reviewed strategy. All stages of the review were completed in duplicate. The primary outcome was mortality and secondary outcomes reflected routinely collected and patient-centered measures; feasibility measures were also collected. Effect estimates were pooled using random-effects models or narratively synthesized. Risk of bias was assessed. Results Seventy studies were included; 45 contributed to meta-analyses. Frailty was defined using 35 different instruments; five were meta-analyzed, with the Fried Phenotype having the largest number of studies. Most strongly associated with: mortality and nonfavorable discharge was the Clinical Frailty Scale (odds ratio, 4.89; 95% CI, 1.83 to 13.05 and odds ratio, 6.31; 95% CI, 4.00 to 9.94, respectively); complications was associated with the Edmonton Frail Scale (odds ratio, 2.93; 95% CI, 1.52 to 5.65); and delirium was associated with the Frailty Phenotype (odds ratio, 3.79; 95% CI, 1.75 to 8.22). The Clinical Frailty Scale had the highest reported measures of feasibility. Conclusions Clinicians should consider accuracy and feasibility when choosing a frailty instrument. Strong evidence in both domains support the Clinical Frailty Scale, while the Fried Phenotype may require a trade-off of accuracy with lower feasibility. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…16 Only a few studies have compared preoperative frailty models in predicting postoperative outcomes. 17 To date and to the best of our knowledge, no study has yet performed a comparison of these three frailty evaluation methods (FRAIL, FI and CFS), especially in China, in patients undergoing elective abdominal surgery. There are different ways to define and assess frailty, leading to prevalence rates ranging from 25% to 46%.…”

Section: Discussionmentioning

confidence: 99%

Comparison of three frailty measures for 90‐day outcomes of elderly patients undergoing elective abdominal surgery

Yin

Jiang

Xue

2020

ANZ Journal of Surgery

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Background: To compare the predictive power of three different evaluation methods of frailty for 90-day outcomes of elderly patients undergoing elective abdominal surgery. Methods: A prospective cohort study was conducted with 194 patients and a postoperative follow-up period of 90 days. Preoperative frailty was evaluated using the five-item FRAIL questionnaire, 54-item frailty index (FI), and nine-item Clinical Frailty Scale (CFS). Receiver operating curves were used to compare the predictive ability for 90-day mortality and long-term hospitalization (LTH), and logistic regression was used to calculate odds ratios and 95% confidence intervals. Results: The incidence rates of frailty assessed using FRAIL, FI, and CFS criteria were 43.8%, 32.5% and 36.6%, respectively. The 90-day mortality and LTH of frail patients were significantly higher than those of non-frail patients regardless of which criteria were used. The CFS and FI predicted 90-day mortality better than FRAIL (CFS versus FRAIL: P = 0.005; FI versus FRAIL: P = 0.041), and the CFS predicted LTH better than FRAIL (P = 0.032). Conclusions: Patients diagnosed with frailty had significantly higher 90-day mortality and LTH regardless of which criteria were used. The CFS and FI were better predictors of 90-day mortality, and the CFS was a better predictor of LTH.

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A Comparison of Two Preoperative Frailty Models in Predicting Postoperative Outcomes in Geriatric General Surgical Patients

Abstract: FP was associated more consistently than CGA with adverse postoperative outcomes in elderly patients undergoing general surgical procedures.

Cited by 14 publications

References 46 publications

Factors Associated with Malnutrition and Its Impact on Postoperative Outcomes in Older Patients

Factors Associated with Malnutrition and Its Impact on Postoperative Outcomes in Older Patients

Accuracy and Feasibility of Clinically Applied Frailty Instruments before Surgery

Comparison of three frailty measures for 90‐day outcomes of elderly patients undergoing elective abdominal surgery

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