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

Richards, Simon; Cherry, Tiffany J; Frizelle, Frank; Eglinton, Tim

doi:10.1111/ans.16319

Cited by 21 publications

(33 citation statements)

References 33 publications

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“…The EFS has been correlated to postoperative complications, length of hospitalization, and readmission in a variety of surgical settings. [17][18][19] However, when compared with the mFI, the EFS identified fewer patients (4.2%) with frailty in the study cohort. Patients who were frail by the EFS score threshold (.7) were likely to have lower hemoglobin and albumin levels, hinting at association of poor nutrition and biochemical variables that correlate with frailty.…”

Section: Discussionmentioning

confidence: 83%

Evaluation of Agreement Among Frailty Assessment Tools in Head and Neck Surgery

Pandey

Aurit

et al. 2022

Otolaryngol.--head neck surg.

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Objective To evaluate intertest agreement among hand grip strength (HGS), the modified Frailty Index (mFI), and the Edmonton Frail Scale (EFS) in patients presenting for presurgical assessment in a head and neck surgery clinic. Study Design Prospective observational study. Setting Academic tertiary medical center. Methods Prospective data relating to 3 frailty measurements were collected for 96 consecutive adults presenting for presurgical counseling at a single high-volume head and neck surgical oncology clinic. Frailty was determined with previously validated thresholds for the mFI (≥3) and EFS (>7). The highest of 2 HGS measurements performed for the dominant hand was used to determine frail status based on previously validated sex- and body mass index–specific thresholds. Baseline characteristics were identified to determine the association of such variables to each tool. Agreement among frailty assessment tools was examined. Results The frequency of frailty in the cohort varied among tools, ranging from 29.2% (28/96) for HGS to 12.5% (12/96) for the mFI and 4.2% (4/96) for the EFS. The overall agreement among the 3 frailty tools via the Fleiss index was poor (kappa, 0.088; 95% CI, –0.028 to 0.203). Conclusion Assessment of frailty is complex, and established frailty assessment tools may not agree on which patients are frail. When assessing a patient as frail, clinicians must be vigilant to the influence of frailty assessment tools on such determinations, which may contribute critical input during shared decision making for patients considering head and neck surgery or nonsurgical alternatives.

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Section: Discussionmentioning

confidence: 83%

Evaluation of Agreement Among Frailty Assessment Tools in Head and Neck Surgery

Pandey

Aurit

et al. 2022

Otolaryngol.--head neck surg.

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“…Both the Edmonton Frail Scale and the Mini-Cog have been found to be predictive of postoperative morbidity, including postoperative neurocognitive disorders. [22][23][24][25][26] For the purposes of this investigation, "cognitive impairment" refers to a Mini-Cog score of 0 to 2, and "frailty" refers to an Edmonton Frail Scale score ≥8.…”

Section: Frailty and Cognitive Screeningmentioning

confidence: 99%

Potentially Inappropriate Medication Administration Is Associated With Adverse Postoperative Outcomes in Older Surgical Patients: A Retrospective Cohort Study

Burfeind¹,

Zarnegarnia²,

Tekkali³

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: The American Geriatrics Society (AGS) Beers Criteria is an explicit list of potentially inappropriate medications (PIMs) best avoided in adults ≥65 years of age. Cognitively impaired and frail surgical patients often experience poor outcomes after surgery, but the impacts of PIMs on these patients are unclear. Our objective was to assess whether perioperative PIM administration was associated with poor outcomes in geriatric surgical patients. We then evaluated the association between PIM administration and postoperative outcomes in subgroups of patients who were frail or cognitively impaired. METHODS: We performed a retrospective cohort study of patients ≥65 years of age who underwent elective inpatient surgery at a large academic medical center from February 2018 to January 2020. Edmonton Frail Scale and Mini-Cog screening tools were administered to all patients at their preoperative clinic visit. A Mini-Cog score of 0 to 2 was considered cognitive impairment, and frailty was defined by an Edmonton Frail Scale score of ≥8. Patients were divided into 2 groups depending on whether they received at least 1 PIM (PIM+), based on the 2019 AGS Beers Criteria, in the perioperative period or none (PIM−). We assessed the association of preoperative frailty, cognitive impairment, and perioperative PIM administration with the length of hospital stay and discharge disposition using multiple regression analyses adjusted for age, sex, ASA physical status, and intensive care unit (ICU) admission. RESULTS: Of the 1627 included patients (mean age, 73.7 years), 69.3% (n = 1128) received at least 1 PIM. A total of 12.7% of patients were frail, and 11.1% of patients were cognitively impaired; 64% of the frail patients and 58% of the cognitively impaired patients received at least 1 PIM. Perioperative PIM administration was associated with longer hospital stay after surgery (PIM−, 3.56 ± 5.2 vs PIM+, 4.93 ± 5.66 days; P < .001; 95% confidence interval [CI], 0.360–0.546). Frail patients who received PIMs had an average length of stay (LOS) that was nearly 2 days longer than frail patients who did not receive PIMs (PIM−, 4.48 ± 5.04 vs PIM+, 6.33 ± 5.89 days; P = .02). Multiple regression analysis revealed no significant association between PIM administration and proportion of patients discharged to a care facility (PIM+, 26.3% vs PIM−, 28.7%; P = .87; 95% CI, −0.046 to 0.054). CONCLUSIONS: Perioperative PIM administration was common in older surgical patients, including cognitively impaired and frail patients. PIM administration was associated with an increased hospital LOS, particularly in frail patients. There was no association found between PIM administration and discharge disposition.

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“…Frailty hat einen erheblichen Einfluss auf das klinische Behandlungsergebnis: So konnten Richards et al [23] bei Patienten, die wegen eines kolorektalen Karzinoms operiert wurden, zeigen, dass Gebrechlichkeit zu einem verlängerten Krankenhausaufenthalt (20 statt 6 Tage) und einer höheren Rate an schweren postoperativen Komplikationen (50 vs. 6,7 %) führte. Weiterhin haben gebrechliche Patienten ein erhöhtes Risiko, ein postoperatives Delir zu entwickeln.…”

Section: Gebrechlichkeit ("Frailty")unclassified

Perioperative Medizin in der Viszeralchirurgie beim alten Patienten aus anästhesiologischer Perspektive

Söhle

Coburn

2021

Zentralbl Chir

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ZusammenfassungDer demografische Wandel führt zu einer zunehmenden Anzahl alter Patienten sowohl in unserer Gesellschaft als auch im Krankenhaus. Mit zunehmendem Alter steigt nicht nur die Anzahl der Vorerkrankungen, sondern auch die postoperative Komplikationsrate und Mortalität. Letztlich ist aber nicht das Alter ausschlaggebend, sondern der Zustand des Patienten und seine Kapazität, sich den körperlichen und mentalen Herausforderungen eines operativen Eingriffs zu stellen. Besonders von Komplikationen bedroht sind gebrechliche Patienten und eine wesentliche – als Prähabilitation – bezeichnete Strategie besteht darin, diese durch körperliches und mentales Training sowie Ernährungsberatung bereits präoperativ in einen besseren Zustand zu versetzen. Das Delir gehört zu den häufigsten postoperativen Komplikationen. Maßnahmen, wie der Verzicht auf eine Prämedikation mit Benzodiazepinen, die Messung der Narkosetiefe, der Verzicht auf langwirksame Opioide, die Durchführung von Fast-Track Surgery sowie die zügige postoperative Bereitstellung von Brille/Hörgerät können das Delirrisiko reduzieren. Eine enge interdisziplinäre Absprache zwischen Chirurgen, Anästhesisten, Geriatern und Physiotherapeuten ist wesentlich, um das perioperative Vorgehen miteinander abzustimmen und das perioperative Risiko für alte Patienten zu reduzieren.

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

Cited by 21 publications

References 33 publications

Evaluation of Agreement Among Frailty Assessment Tools in Head and Neck Surgery

Evaluation of Agreement Among Frailty Assessment Tools in Head and Neck Surgery

Potentially Inappropriate Medication Administration Is Associated With Adverse Postoperative Outcomes in Older Surgical Patients: A Retrospective Cohort Study

Perioperative Medizin in der Viszeralchirurgie beim alten Patienten aus anästhesiologischer Perspektive

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