Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

Abstract

Frailty is defined as diminished physiological reserve predisposing one to adverse outcomes when exposed to stressors. Currently, there is no standardized Frail assessment tool used perioperatively. Edmonton Frail Scale (EFS), which is validated for use by non-geriatricians and in selected surgical populations, is a candidate for this role. However, little evaluation of its use has been carried out in the Asian populations so far. This is a prospective observational study done among patients aged 70 years and above attended Preoperative Assessment Clinic (PAC) in Singapore General Hospital prior to major abdominal surgery from December 2017 to September 2018. The Comprehensive Complication Index (CCI) and Postoperative Morbidity Survey (POMS) were used to assess their postoperative morbidity respectively. Patient’s acceptability of EFS was measured using the QQ-10 questionnaire and the inter-rater reliability of EFS was assessed by Kappa statistics and Bland Altman plot. The primary aim of this study is to assess if frailty measured by EFS is predictive of postoperative complications in elderly patients undergoing elective major abdominal surgery. We also aim to assess the feasibility of implementing EFS as a standard tool in the outpatient preoperative assessment clinic setting. EFS score was found to be a significant predictor of postoperative morbidity. (OR 1.35, p < 0.001) Each point increase in EFS score was associated with a 3 point increase in CCI score. (Coefficient b 2.944, p < 0.001) EFS score more than 4 has a fair predictability of both early and 30-day postoperative complications. Feasibility study demonstrated an overall acceptance of the EFS among our patients with good inter-rater agreement.

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

“…Although EFS did not meet the statistical criteria of P \ 0.1 for postoperative complications, it was included in the final regression model because there is strong evidence in the literature suggesting otherwise. 16,17 We also performed a stratified regression analysis to evaluate the modifying effect of surgical disciplines on postoperative complications and hospital LOS. To adjust for multiple comparisons in the analyses, we applied Bonferroni correction to the original alpha value of statistical significance of 0.05 by dividing it by 5 to reflect the five surgical disciplines.…”

Frailty in the over 65’s undergoing elective surgery (FIT-65) – a three-day study examining the prevalence of frailty in patients presenting for elective surgery

“…A second study team member blinded to the participant's pre-operative dataset completed the REFS prior to surgery. Based on the REFS score (out of a maximum eighteen) participants were classi ed as Not Frail (0-5); Vulnerable (6-7); Mildly Frail (8-9); Moderately Frail (10)(11); Severely Frail (12)(13)(14)(15)(16)(17)(18). Intra-operative and recovery data were collected once patients had returned to the ward or surgical day unit.…”

“…The ideal tool for screening in the pre-operative setting would be time and staff-e cient, easy to perform, objective, and with high sensitivity and speci city. The Edmonton Frail Scale (EFS) has evidence for use in the perioperative setting (10) and is a tool supported by the British Geriatric Society (BGS) (3). It is quick to perform taking approximately ve minutes to complete and, importantly, is able to assess multiple domains of frailty which may be subject to optimisation in the pre-operative period (11).…”

Oncogeriatric. Other frailty assessment instruments

“…It has also been shown to be able to predict postoperative outcomes when used as a screening tool in the Caucasian and Asian population. In studies by He Y., Dasgupta M., increasing EFS scores were, independent of the age, associated with increased length of hospital stay, postoperative complications, in various abdominal operations [24,25]. Moreover, The European Society of Anaesthesiology recommends the use of the EFS in preoperative evaluation of older patients [26].…”