Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis

Gong, Selena; Qian, Dorothy; Riazi, Sheila; Chung, Frances; Englesakis, Marina; Li, Qixuan; Huszti, Ella; Wong, Jean

doi:10.1213/ane.0000000000006272

Cited by 19 publications

(12 citation statements)

References 51 publications

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“…However, the assessment instrument used in this study is the FRAIL scale, which has the advantages of briefness, accuracy, and ease of administration. Our ndings support that the FRAIL scale can predict adverse events in the postoperative period, which is consistent with the results of previous studies [19,22,23] .…”

Section: Discussionsupporting

confidence: 93%

Association of preoperative frailty with adverse postoperative outcomes in elderly patients undergoing elective spinal surgery: A prospective cohort study

Song,

Wu,

Zhao

et al. 2024

Preprint

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Background This study aims to investigate the relationship between a brief preoperative frailty assessment and the occurrence of adverse postoperative outcomes in elective spinal surgery in the elderly. Methods This is a prospective cohort study. The participants selected for the study were elderly patients undergoing elective spinal surgery at Shengjing Hospital of China Medical University. A total of 231 elderly patients aged 65 years or older were assessed for preoperative frailty using the FRAIL scale, a brief frailty screening scale that covers five main aspects: fatigue, resistance, mobility, disease status, and weight, within 1 week before surgery. Follow-up was conducted within 30 days after surgery to obtain information about postoperative recovery. The primary outcome indicator was the occurrence of postoperative complications. Complications of interest included postoperative infections (respiratory, urinary, and surgical site infections), cardiovascular complications, blood transfusions, electrolyte disturbances, and problems with postoperative feeding. Secondary outcome indicators were prolonged hospital stay and adverse postoperative course. Results A total of 207 patients were eventually analyzed in this study, of whom 101 (48.8%) were male and 106 (51.2%) were female. The median age of the cohort was 69 (67–72) years. Preoperative frailty assessment resulted in 30 (14.5%) being healthy, 121 (58.5%) being prefrail and 56 (27.1%) being frail. A total of 65 (31.4%) of the 207 patients experienced postoperative complications. In a multifactorial analysis, frailty (score ≥ 3) (OR, 4.80; 95% CI, 1.1-20.96) and ASA classification ≥ 3 (OR, 2.53; 95% CI, 1.23–5.21) were independent risk factors for the development of postoperative complications. ASA classification ≥ 3 (OR, 2.21; 95% CI, 1.046–4.69) was significantly associated with a prolonged hospital stay. Patients with frailty (score ≥ 3) (OR, 6.426; 95%CI, 1.13–36.69) or ASA classification ≥ 3 (OR, 4.10; 95% CI, 1.71–9.83) were at increased risk of adverse postoperative course (CCI above the 75th percentile). Conclusions In geriatric elective spinal surgery, preoperative assessment with the brief frailty screening scale can help identify individuals at high potential risk of postoperative adverse events. Trial registration: This study was initially registered in the Chinese Clinical Trial Registry on 8/8/2021 under the registration number ChiCTR2100049677.

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Section: Discussionsupporting

confidence: 93%

Association of preoperative frailty with adverse postoperative outcomes in elderly patients undergoing elective spinal surgery: A prospective cohort study

Song,

Wu,

Zhao

et al. 2024

Preprint

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“…The original cognitive battery included Montreal Cognitive Assessment (MOCA) (Spanish version and telehealth or blind version as necessary), 24,25 Hopkins Verbal Learning Test Revised (HVLTR), 26 copy gure from Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), 27 Geriatric Depression Scale (GDS) (available in multiple languages including English, Spanish and Portuguese), 28 and the FRAIL scale. 29 The modi ed cognitive battery only included the MOCA, GDS, and the FRAIL scale. MK, a neuropsychologist at the University of Miami, developed the protocol for virtual cognitive test visits according to her clinical practice.…”

Section: Study Proceduresmentioning

confidence: 99%

A Single-Center, Prospective, Pilot Cohort Study of Preoperative Abnormal Sleep Patterns and Postoperative Delirium in Older Hispanic/Latino Patients Undergoing Cardiac Surgery.

Mahanna-Gabrielli,

Le,

Shrestha

et al. 2023

Preprint

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Background Delirium occurs in 20–50% of older patients after cardiac surgery and is associated with prolonged intensive care and hospital length of stay, postoperative cognitive decline, and dementia. Preoperative abnormal sleep patterns are potentially modifiable risk factors that have been associated with an increased incidence of postoperative delirium. Hispanic/Latinos may be a particularly vulnerable population given their higher prevalence of risk factors for delirium including cognitive impairment, lower level of education, and sleep disturbances, as compared to non-Hispanic White adults. A largescale cohort study is needed to determine if altered sleep patterns increase the risk of delirium in older, Hispanic/Latino patients after cardiac surgery. The primary aims of this pilot study were to determine the feasibility of recruitment, retention, preoperative sleep actigraphy measurements, preoperative sleep questionnaire and cognitive batteries, and postoperative delirium testing. Methods We conducted a single-center, prospective, pilot cohort study of older Hispanic/Latino patients undergoing cardiac surgery with and without preoperative sleep disturbances and postoperative delirium from February 2020 to December 2021 at UHealth of the University of Miami, an academic tertiary center in Miami, FL. Patients underwent preoperative cognitive and sleep questionnaire testing and wore an actigraphy wristwatch with a sleep diary for 5 to 7 days prior to surgery. Postoperatively patients were tested for delirium for up to 7 days or hospital discharge. Feasibility of the study protocol was the primary objective of this pilot study. Results 155 patients were screened, 40 met full inclusion criteria, and 14 patients were recruited. The mean age was 67.2 years old. Spanish was the preferred language in 21.4% of patients. Poor sleep quality was present in 78.5% of subjects. 57.1% of subjects experienced either delirium or subsyndromal delirium. Despite being conducted during the height of the COVID-19 pandemic, our pilot trial met our a priori thresholds for specific feasibility criteria. Conclusions The protocol was feasible and a future, definitive prospective cohort study of older Hispanic/Latino patients undergoing cardiac surgery with and without preoperative altered sleep patterns and an outcome of postoperative delirium will be planned. Trial registration: The study was registered at ClinicalTrials.gov on March 8, 2021 (NCT04786899)

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“…They also reported that the presence of frailty was a predictor of postoperative neurological, renal, vascular, and respiratory system complications in patients who went through both cardiac and non-cardiac surgical procedures. 32 Even though the mechanism remains unclear, the surge in neuroinflammatory mediators following both cardiac and non-cardiac surgical interventions has been reported to be a strong predictor of POCD. We have seen that most of the literature in this review article supported this argument (n=8).…”

Section: Dovepressmentioning

confidence: 99%

Incidence and Factors Related to Prolonged Postoperative Cognitive Decline (POCD) in Elderly Patients Following Surgery and Anaesthesia: A Systematic Review

Arefayne,

Berhe,

van Zundert

2023

JMDH

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The aim of this systematic review is to explore the current literature to provide evidence regarding the incidence and risk factors of prolonged POCD in elderly patients following cardiac and non-cardiac surgical interventions. Methods: The PubMed and Google Scholar databases were searched using appropriate keywords and search engines for adequate evidence from studies meeting the inclusion criteria so as to reveal the end-point, which was the presence of prolonged POCD in elderly patients following surgery and anaesthesia. The incidence of POCD at different time intervals and the variables predicting the occurrence of POCD were analysed. Results:The results of 23 articles covering 5077 patients (3694 non cardiac and 1383 cardiac surgeries) were carefully analysed. POCD occurs from the first postoperative day and lasts for potentially long periods. The incidence of POCD in this review ranged from 2.2% to 35.7%. More specifically, it ranged from 2.2% to 31.5% in non-cardiac surgeries and 11.8% to 35.7% in patients who had undergone cardiac surgeries. Some of the independent risk factors (predictors) for the development of POCD were advanced age, high concentration of neuroinflammatory mediators detectable in plasma, low SpO 2 , longer anaesthetic and surgical duration, and depth of anaesthesia. Conclusion:This review can only provide limited evidence of prolonged POCD (more than a year) and further research that involves better study designs, larger samples, involving longer follow-up, and at different sites (multicentre) is highly advised. This in turn may help researchers and clinicians to discover the actual causes and risk factors and develop appropriate preventive and treatment protocols to tackle POCD in the ageing surgical population.

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Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis

Cited by 19 publications

References 51 publications

Association of preoperative frailty with adverse postoperative outcomes in elderly patients undergoing elective spinal surgery: A prospective cohort study

Association of preoperative frailty with adverse postoperative outcomes in elderly patients undergoing elective spinal surgery: A prospective cohort study

A Single-Center, Prospective, Pilot Cohort Study of Preoperative Abnormal Sleep Patterns and Postoperative Delirium in Older Hispanic/Latino Patients Undergoing Cardiac Surgery.

Incidence and Factors Related to Prolonged Postoperative Cognitive Decline (POCD) in Elderly Patients Following Surgery and Anaesthesia: A Systematic Review

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