Prevalence of frailty and its association with mortality in general surgery

Hewitt, Jonathan; Moug, Susan; Middleton, Maeve; Chakrabarti, Mohua; Stechman, M J; McCarthy, Kathryn

doi:10.1016/j.amjsurg.2014.05.022

Cited by 147 publications

(136 citation statements)

References 18 publications

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“…13 The handful of prior studies conducted in a surgical setting largely reported adverse prognosis for patients with frailty, but were mostly restricted to specific procedures and short follow-up periods. [23][24][25][26][27] Very few studies have assessed a dose-response relation. Among 325 older patients who underwent general surgery, no difference was found in unadjusted 30-day readmission rates between frail and nonfrail patients, where frailty was defined by Clinical Frailty Scale scores of 5 or higher.…”

Section: Discussionmentioning

confidence: 99%

“…Among 325 older patients who underwent general surgery, no difference was found in unadjusted 30-day readmission rates between frail and nonfrail patients, where frailty was defined by Clinical Frailty Scale scores of 5 or higher. 23 However, in 383 adult kidney transplant recipients, frailty classified by the Fried criteria identified a 60% increased risk of 30-day readmission. 24 Furthermore, in a retrospective study of 5627 adults who underwent posterior cervical fusion, each additional point on a frailty-based index conferred a 40% increased risk of 30-day readmission, 25 similar to the 35% increase in risk per additional point in the Clinical Frailty Scale observed in our study.…”

Section: Discussionmentioning

confidence: 99%

“…We also conducted a post hoc sensitivity analysis excluding patients who underwent cancer surgery. We considered the Clinical Frailty Scale as a dichotomized variable, applying a well-balanced cut-off score of 4 (rather than 5, as used previously 5,22,23 ), because our cohort excluded patients with scores of 7 or higher. Finally, we disaggregated composite outcomes to identify whether readmission or death was driving the relation.…”

Section: Discussionmentioning

confidence: 99%

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Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

Pederson

Churchill

et al. 2018

CMAJ

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Frailty is a state of vulnerability to diverse stressors. We assessed the impact of frailty on outcomes after discharge in older surgical patients. METHODS:We prospectively followed patients 65 years of age or older who underwent emergency abdominal surgery at either of 2 tertiary care centres and who needed assistance with fewer than 3 activities of daily living. Preadmission frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale as "well" (score 1 or 2), "vulnerable" (score 3 or 4) or "frail" (score 5 or 6). We assessed composite end points of 30-day and 6-month all-cause readmission or death by multivariable logistic regression. (n = 3 [4.2%]). By 6 months, the degree of frailty independently and dose-dependently predicted readmission or death: 56 (33.3%) of the vulnerable patients (adjusted OR 2.15, 95% CI 1.01-4.55) and 37 (54.4%) of the frail patients (adjusted OR 3.27, 95% CI 1.32-8.12) were readmitted or had died, compared with 11 (15.3%) of the patients who were well. INTERPRETATION:Vulnerability and frailty were prevalent in older patients undergoing surgery and unlikely to trigger specialized geriatric assessment, yet remained independently associated with greater risk of readmission for as long as 6 months after discharge. Therefore, the degree of frailty has important prognostic value for readmission. Trial registration for primary study: ClinicalTrials. gov, no. NCT02233153

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

Pederson

Churchill

et al. 2018

CMAJ

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“…For example, 40 % of the older emergency medical admissions (mean age 83 years) were identified as frail according to the Cardiovascular Health Study phenotype definition in a Belgium study (85) and a recent prospective study in the UK identified 28 % of older patients (mean age 77 years) attending three acute surgical admission units as frail (86) . In the outpatient setting, 26 % of urology, surgical oncology and general surgery patients in the USA (mean age 62 years) were deemed frail or pre-frail (87) and 37·0 % of men and 29·3 % of women (mean age 64 years) attending a dialysis unit in Korea had sarcopenia (defined as low muscle mass and strength) (88) .…”

Section: Sarcopenia and Frailty In Clinical Practicementioning

confidence: 99%

Ageing well: a review of sarcopenia and frailty

2015

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Conference on 'Nutrition and age-related muscle loss, sarcopenia and cachexia' 'Ageing well' has been declared a global health priority by the World Health Organisation and the role of sarcopenia and frailty in late-life health is receiving increasing attention. Frailty is the decline in an individual's homeostatic function, strength and physiologic reserves leading to increased vulnerability, while sarcopenia describes the loss of muscle mass and function with age. The conceptual definitions of these conditions have been widely agreed but there is a lack of consensus on how to measure them. We review the different operational definitions described in the literature and the evidence that, whatever definition used, the prevalence and clinical impact of these conditions is high. We also consider the commonality of low physical function to both conditions, a feature which could provide a pragmatic way forward in terms of identifying those at risk. Objective measures of physical function such as usual walking speed are simple and feasible measures, extensively validated against health outcomes. Additionally, clinical applications of sarcopenia and frailty are reviewed with particular consideration to their potential role in the management of older people undergoing surgery. Frailty appears to outperform traditional anaesthetic and surgical risk scores in terms of its association with post-operative complications, length of hospital stay, institutionalisation and mortality. However, even within this sub-specialty area there is wide variation in the approaches used to measure frailty and there is an urgent need for studies to utilise established, validated and reproducible methods to identify sarcopenia and frailty in their study participants, in order to expedite scientific development. Sarcopenia: Frail elderly: AgeingBy 2050 the proportion of the world's population aged ⩾60 years is projected to be 22 %, double the proportion recorded at the turn of the new millennium (1) . Although population ageing is in one way a great public health success story, with mortality rates among older people continuing to fall (2) , in another way it presents significant challenges. For example, in the UK 60 % of people admitted to hospital are ⩾65 years old despite this age-group only comprising 17 % of the total UK population (3) . This disproportionate use of healthcare services by older people not only demonstrates the significant economic implications of an ageing population (4) , but also the morbidity experienced by many older people, reducing quality of life. However, it is not inevitable that *Corresponding author: Dr V. L. Keevil, fax +44 (0)1223 748676, email vlk20@cam.ac.uk Abbreviations: CGA, comprehensive geriatric assessment; FI, frailty index; PFP, physical frailty phenotype.

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“…However, surgeons have little knowledge of the assessment and management of preoperatively identifiable age-related factors that affect outcomes. Frailty, poor functional status, cognitive impairment and postoperative delirium in older people have all been shown to be associated with prolonged postoperative stay, adverse postoperative outcomes, [13][14][15][16][17] and postoperative discharge to a higher level of care. 18 The prevalence and severity of postoperative complications in an older surgical patient has also been shown to have a negative effect on the time take to return to baseline functional status.…”

Section: Preoperative Carementioning

confidence: 99%

Surgery in the older person: Training needs for the provision of multidisciplinary care

Pearce

Bunni

McCarthy

et al. 2016

annals

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INTRODUCTION Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. METHODS We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. FINDINGS The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population. Management of the older surgical patient throughout the surgical pathway forms part of the Specialty Training Curriculum for Geriatric Medicine. While 'surgery in childhood' continues to form part of the general surgical higher training syllabus, surgery in the later years of life does not. There are limited postgraduate courses and training opportunities currently available to surgeons in this field. There is clear societal need to address perioperative care for older surgical patients, which has proved successful in some centers. Moreover, surgical trainees support the inclusion of geriatric medicine issues into their training. CONCLUSIONS The ageing population requires a multidisciplinary perioperative approach, with dedicated and appropriately trained clinicians and allied health care professionals to improve outcomes.

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Prevalence of frailty and its association with mortality in general surgery

Cited by 147 publications

References 18 publications

Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

Ageing well: a review of sarcopenia and frailty

Surgery in the older person: Training needs for the provision of multidisciplinary care

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