Postoperative Recovery in Frail, Pre‐frail, and Non‐frail Elderly Patients Following Abdominal Surgery

Sikder, Tarifin; Sourial, Nadia; Maimon, Geva; Tahiri, Mehdi; Teasdale, Debby; Bergman, Howard; Fraser, Shannon A.; Demyttenaere, Sebastian; Bergman, Simon

doi:10.1007/s00268-018-4801-9

Cited by 18 publications

(16 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although frail patients had a reduced baseline QOL and an increased rate of adverse outcomes, they did not suffer from a greater reduction in QOL as a result of surgery. Sikder et al 27 . also concluded that frailty was not associated with reduced of QOL or cognition as a result of surgery.…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Pre‐operative frailty is predictive of adverse post‐operative outcomes in colorectal cancer patients

Richards

Cherry

Frizelle

et al. 2020

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background An increasing number of elderly patients are presenting for elective surgery. Pre‐operative risk assessment in this population is inexact due to the complex interplay between age, comorbidity and functional status. Frailty assessment may provide a surrogate measure of a patient's physiological reserve and aid operative decision‐making. The aim of this study is to determine the association between pre‐operative frailty, as assessed using the Edmonton Frail Scale, and post‐operative outcomes in elderly patients undergoing elective colorectal cancer surgery. Methods A prospective analysis of 86 patients over the age of 65 undergoing elective colorectal cancer surgery at a tertiary centre between October 2017 and October 2018 was performed. Frailty assessment was conducted pre‐operatively using the Edmonton Frail Scale. Primary outcomes included length of stay and post‐operative complication rates. Multivariable logistic regression analyses were used to determine the influence of frailty on post‐operative outcomes including mortality, prolonged hospital admission, complication rates and quality of life. Results Of 86 patients, 12 (14.0%) were identified as frail. Frailty was associated with a significantly increased median length of stay (20 days versus 6 days, incidence rate ratio 2.83, P < 0.01) and a significantly increased risk of major post‐operative complications (50.0% versus 6.7%, odds ratio 13.8, P < 0.01). Frailty was not associated with a significant reduction in quality of life scores at 30 and 90 days post‐operatively. Conclusion Frailty is associated with adverse post‐operative outcomes in elderly patients undergoing elective colorectal cancer surgery. Frailty assessment is an important component of pre‐operative risk assessment and may identify targets for pre‐operative optimisation.

show abstract

Section: Discussionmentioning

confidence: 96%

“…Most surgical studies investigating frailty focus on outcomes such as LOS, complication rates or oncological outcomes 26,27 . These may not be a priority to elderly patients and incompletely describe their recovery process 28 .…”

Section: Discussionmentioning

confidence: 99%

Pre‐operative frailty is predictive of adverse post‐operative outcomes in colorectal cancer patients

Richards

Cherry

Frizelle

et al. 2020

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Poorer outcomes have been consistently reported with increasing age 1,20,[25][26][27][28] . Indeed, results from this study found that age had a similar linear relationship to increased level of care on discharge from hospital found with frailty.…”

Section: Key Findingsmentioning

confidence: 91%

Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy

Carter

Law

Hewitt

et al. 2020

British Journal of Surgery

View full text Add to dashboard Cite

Background Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge. Methods The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level. Results A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit. Conclusion Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.

show abstract

“…Twenty-five studies reported discharge disposition data (Supplemental Digital Content, table 4, http://links.lww. com/ALN/C333), defined as new admission to nursing home, transitional care, or rehabilitation facility (total n = 6,558); 6,32,33,35,37,39,40,46,48,55,57,58,62,63,70,76,77,[83][84][85]92,94,95,101,102 six studies reported outcome data for more than one instrument. 6,32,40,48,55,58 Eleven studies included the Fried Phenotype 4,6,32,33,35,37,39,46,48,53,55,[57][58][59] (n = 3,202; odds ratio, 5.18; 95% CI, 3.34 to 8.03; P < 0.0001; I 2 = 56.4; Supplemental Digital Content, fig.…”

Section: Discharge Dispositionmentioning

confidence: 99%

Accuracy and Feasibility of Clinically Applied Frailty Instruments before Surgery

Aucoin¹,

Hao²,

Sohi³

et al. 2020

Anesthesiology

158

171

View full text Add to dashboard Cite

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

show abstract

Postoperative Recovery in Frail, Pre‐frail, and Non‐frail Elderly Patients Following Abdominal Surgery

Abstract: Strong, institutional commitment to quality surgical care, as well as appropriate strategies for older patients, may have mitigated the impact of frailty on recovery. Further research is needed to examine the role of frailty in the surgical recovery process.

Cited by 18 publications

References 70 publications

Pre‐operative frailty is predictive of adverse post‐operative outcomes in colorectal cancer patients

Pre‐operative frailty is predictive of adverse post‐operative outcomes in colorectal cancer patients

Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy

Accuracy and Feasibility of Clinically Applied Frailty Instruments before Surgery

Contact Info

Product

Resources

About