Accuracy of the Clinical Frailty Scale for perioperative frailty screening: a prospective observational study

Abstract

Purpose Perioperative frailty increases postoperative complications, mortality, and new functional dependence. Despite this, routine perioperative frailty screening is not widespread. We aimed to assess the accuracy of the Clinical Frailty Scale (CFS) as a screening tool prior to anesthesia, and to determine which health domains are affected by frailty. Methods In a prospective, single-centre observational study, we enrolled 218 patients aged C 65 yr undergoing elective and emergency surgery. The screening performance of the CFS was compared with the Edmonton Frail Scale, including the effect in individual frailty domains, and outcomes including discharge location and mortality. Results The median [interquartile range] age of the enrolled subjects was 74 [69-80] yr and 24% of the patients were frail. The CFS and Edmonton scales were highly correlated (Spearman correlation coefficient, 0.81; 95% confidence interval [CI], 0.77 to 0.86), and in substantial agreement (kappa coefficient, 0.76; 95% CI, 0.70 to 0.81), with an area under the receiver operating characteristic curve of 0.91 (95% CI, 0.86 to 0.94) indicating excellent discrimination for the CFS in predicting frailty status based on the Edmonton scale. Frail patients had higher 30-day mortality (odds ratio, 5.26; 95% CI, 1.28 to 21.62), and were less likely to be discharged home. Frail patients had poorer health throughout frailty domains, including functional dependence (42% of frail vs 4% of non-frail patients; P \0.001), malnutrition (48% vs 19%, P\0.001), and poor physical performance (47% vs 7%, P \ 0.001). Conclusion The CFS is a valid and accurate tool to screen for perioperative frailty, which encompasses the spectrum of health-related domains.

Prevalence and risk factors of preoperative malnutrition risk in older patients and its impact on surgical outcomes: a retrospective observational study

“…24 Moreover, the EFS has shown good correlation with surgical outcomes including postoperative complications, 16,17 hospital LOS, 25 and postoperative mortality. 26 While the clinical frailty score has similar accuracy as EFS in identifying frail patients perioperatively, 27 it requires subjective clinical judgement so can be limited by inter-assessor variability. 28,29 It also does not include cognition and psychosocial assessment.…”

Comparison of geriatric assessment tools for frailty among community elderly

“…This outcome is similar to a study that used the CFS compared with comprehensive geriatric assessment in the emergency department in the West of Ireland and found that the CFS has the following: sensitivity 51%, specificity 94%, PPV 93%, and NPV 57% when using the cut point of frailty at ≥ 5 [ 42 ]. A study that compared CFS screening and the Edmonton Frail Scale in the perioperative department of the Royal Melbourne Hospital revealed that the CFS has a sensitivity of 80.8% and specificity of 88.6% when using a CFS at ≥ 5 and that the area under the receiver operating characteristic curve was 0.91 (95% CI, 0.86 to 0.94) [ 43 ].…”

Translation and validation of the Korean version of the clinical frailty scale in older patients

“…In this study, the newly translated Korean version of CFS recognized frail patients more effectively than other scales. Previous studies have suggested the CFS is a useful screening tool based on clinical judgement for measuring frailty [8,14]. the translated version was also administered successfully.…”

“…Frailty is either physical or psychological or a combination of both [2]. Physical frailty is characterized by diminished strength and endurance and reduced physiologic function [1] and associated with increased health-related outcomes in older populations, including hospitalization, nursing home admission, re-admission, and mortality [3][4][5][6][7][8][9][10]. Therefore, for physicians, frailty screening is useful for risk stratification, goal setting and advanced care planning, and frailty-targeted interventions [1,[11][12][13].…”