Association of frailty with short-term outcomes, organ support and resource use in critically ill patients

Zampieri, Fernando G.; Iwashyna, Theodore J.; Viglianti, Elizabeth M.; Taniguchi, Leandro Utino; Viana, William N.; Costa, Roberto; Corrêa, Thiago Domingos; Moreira, Carlos Eduardo Nassif; Maia, Marcelo O.; Moralez, G. M.; Lisboa, Thiago; Ferez, Marcus Antônio; Freitas, C.; Carvalho, Clayton Barbieri de; Mazza, Bruno Franco; Lima, Mariza F. A.; Ramos, Grazielle Viana; Silva, Aline R.; Bozza, Fernando A.; Salluh, Jorge I.; Soares, Márcio

doi:10.1007/s00134-018-5342-2

Cited by 127 publications

(113 citation statements)

References 28 publications

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“…Despite the ease of CFS application in critical care and its predictive validity [3,4], the relative advantages and disadvantages of CFS vs. other frailty assessment tools (e.g. frailty index generated from routinely collected data [18,20,21]) are underexplored in this setting.…”

Section: Discussionmentioning

confidence: 99%

Reliability of frailty assessment in the critically ill: a multicentre prospective observational study

et al. 2019

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Demand for critical care among older patients is increasing in many countries. Assessment of frailty may inform discussions and decision making, but acute illness and reliance on proxies for history-taking pose particular challenges in patients who are critically ill. Our aim was to investigate the inter-rater reliability of the Clinical Frailty Scale for assessing frailty in patients admitted to critical care. We conducted a prospective, multi-centre study comparing assessments of frailty by staff from medical, nursing and physiotherapy backgrounds. Each assessment was made independently by two assessors after review of clinical notes and interview with an individual who maintained close contact with the patient. Frailty was defined as a Clinical Frailty Scale rating > 4. We made 202 assessments in 101 patients (median (IQR [range]) age 69 (65-75 [60-80]) years, median (IQR [range]) Acute Physiology and Chronic Health Evaluation II score 19 (15-23 [7-33])). Fifty-two (51%) of the included patients were able to participate in the interview; 35 patients (35%) were considered frail. Linear weighted kappa was 0.74 (95%CI 0.67-0.80) indicating a good level of agreement between assessors. However, frailty rating differed by at least one category in 47 (47%) cases. Factors independently associated with higher frailty ratings were: female sex; higher Acute Physiology and Chronic Health Evaluation II score; higher category of pre-hospital dependence; and the assessor having a medical background. We identified a good level of agreement in frailty assessment using the Clinical Frailty Scale, supporting its use in clinical care, but identified factors independently associated with higher ratings which could indicate personal bias.

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Section: Discussionmentioning

confidence: 99%

Reliability of frailty assessment in the critically ill: a multicentre prospective observational study

et al. 2019

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“…Moreover, such people have a lower chance of returning home with functional independence and have poorer quality of life if they survive the surgery and its complications . The 1‐year costs of care for such people were higher compared with costs for those who were not frail . This association of frailty with poor surgical outcomes appears to be independent of critical illness severity, suggesting that opportunities may exist to modify preoperative frailty and improve post‐operative outcomes.…”

Section: Frailty In Older People Undergoing Surgery: Prevalence and Amentioning

confidence: 99%

“…27 The effect of frailty on outcomes after elective surgery is increasingly described in hospital-based 24,25,[28][29][30][31] and population-based studies. 32,33 Outcomes such as increased mortality 31 especially after emergency surgery, 34 greater intensive care unit readmission rates, 26 longer hospital length of stay, 24,27,35 hospital readmission rates, 36 increased postoperative delirium 30 and other complications 35,36 occur more frequently in frail people undergoing surgery. A recent systematic review of nine observational studies of post-operative general surgical patients (n = 2241) identified higher 30-day mortality in frail group when compared to pre-frail group (8% versus 1%).…”

Section: Frailty In Older People Undergoing Surgery: Prevalence and Amentioning

confidence: 99%

“…5,24,26,27,[36][37][38][39][40][41] The 1-year costs of care for such people were higher compared with costs for those who were not frail. 34 This association of frailty with poor surgical outcomes appears to be independent of critical illness severity, 26,42 suggesting that opportunities may exist to modify preoperative frailty and improve post-operative outcomes.…”

Section: Frailty In Older People Undergoing Surgery: Prevalence and Amentioning

confidence: 99%

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Frailty in the older person undergoing elective surgery: a trigger for enhanced multidisciplinary management – a narrative review

Subramaniam

Tiruvoipati

Lodge

et al. 2020

ANZ Journal of Surgery

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Background The ageing of our society has led to increasing numbers of older people requiring elective surgical procedures. Preoperative frailty is a strong predictor of adverse post‐operative outcomes. This review aims to summarize the evidence for interventions aimed at improving outcomes in frail older people who may undergo elective surgery. Methods Articles published on perioperative management of frailty between 1 January 1970 and 31 May 2019 were searched using PubMed and EMBASE. Results We identified very few studies investigating such interventions, such as comprehensive geriatric assessment, prehabilitation (alone or as a multicomponent strategy) and other multicomponent interventions. Administration of a comprehensive geriatric assessment was shown to be associated with reduced mortality, fewer complications and shorter length of hospital stay, and may be best targeted towards those who are identified as frail for resource efficiency. Multicomponent interventions including prehabilitation may be associated with improved outcomes, but the evidence base for these needs to be strengthened. Conclusion Establishing multidisciplinary collaborative services to provide person‐centred models of care should be considered for older people presenting for elective surgery, particularly in those with greater preoperative frailty. Further large‐scale studies should focus on implementing and evaluating such multicomponent models of care.

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“…The ability to risk stratify critically ill patients and target intensive care unit resources to those who benefit the most is appealing and has resulted in a growing interest in the search for novel risk factors [1,2]. Performance status has gained significant attention recently [3,4]. In the same line, poor nutritional status, often judged by a low body mass index (BMI), is a prominent factor associated with poor short-and long-term outcomes [5,6].…”

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confidence: 99%

Will my patient survive? Look for creatinine in the urine!

2018

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Association of frailty with short-term outcomes, organ support and resource use in critically ill patients

Abstract: Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support.

Cited by 127 publications

References 28 publications

Reliability of frailty assessment in the critically ill: a multicentre prospective observational study

Reliability of frailty assessment in the critically ill: a multicentre prospective observational study

Frailty in the older person undergoing elective surgery: a trigger for enhanced multidisciplinary management – a narrative review

Will my patient survive? Look for creatinine in the urine!

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