The Edmonton Frail Scale Improves the Prediction of 30-Day Mortality in Elderly Patients Undergoing Cardiac Surgery: A Prospective Observational Study

Amabili, Philippe; Wozolek, Aaron; Noirot, Ines; Roediger, Laurence; Sénard, Marc; Donneau, Anne‐Françoise; Hubert, Marie Bernard; Brichant, Jean-François; Hans, Grégory

doi:10.1053/j.jvca.2018.05.038

Cited by 42 publications

(43 citation statements)

References 26 publications

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“…Previous work on the perioperative use of EFS has been focused on its predictability of postoperative mortality and length of hospital stay, but little attention has been given to the exact EFS score that could help with risk stratification in the surgical population 11,33,34 . Currently, there is no consensus on the use of EFS cut-off scores to define non-frail, vulnerable and frail among the clinicians globally.…”

Section: Discussionmentioning

confidence: 99%

Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

Hao

et al. 2020

Sci Rep

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Frailty is defined as diminished physiological reserve predisposing one to adverse outcomes when exposed to stressors. Currently, there is no standardized Frail assessment tool used perioperatively. Edmonton Frail Scale (EFS), which is validated for use by non-geriatricians and in selected surgical populations, is a candidate for this role. However, little evaluation of its use has been carried out in the Asian populations so far. This is a prospective observational study done among patients aged 70 years and above attended Preoperative Assessment Clinic (PAC) in Singapore General Hospital prior to major abdominal surgery from December 2017 to September 2018. The Comprehensive Complication Index (CCI) and Postoperative Morbidity Survey (POMS) were used to assess their postoperative morbidity respectively. Patient’s acceptability of EFS was measured using the QQ-10 questionnaire and the inter-rater reliability of EFS was assessed by Kappa statistics and Bland Altman plot. The primary aim of this study is to assess if frailty measured by EFS is predictive of postoperative complications in elderly patients undergoing elective major abdominal surgery. We also aim to assess the feasibility of implementing EFS as a standard tool in the outpatient preoperative assessment clinic setting. EFS score was found to be a significant predictor of postoperative morbidity. (OR 1.35, p < 0.001) Each point increase in EFS score was associated with a 3 point increase in CCI score. (Coefficient b 2.944, p < 0.001) EFS score more than 4 has a fair predictability of both early and 30-day postoperative complications. Feasibility study demonstrated an overall acceptance of the EFS among our patients with good inter-rater agreement.

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Section: Discussionmentioning

confidence: 99%

Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

Hao

et al. 2020

Sci Rep

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“…Alfredsson et al [ 21 ] reported that the slowest walkers in their study had a 35% higher 30-day mortality than normal walkers, and each 0.2-m/s decrease in gait speed corresponded to an 11% mortality increase. Although the EFS applied in this study has not been subject to validation in a population with TAVR, it demonstrated good predictability of 30-day mortality in older patients after cardiac surgery [ 22 ]. The differences in the findings may be attributed to the smaller population examined in this study; however, the ability of the FIFA score to predict short-term mortality within our initial study population is promising.…”

Section: Discussionmentioning

confidence: 99%

Fitness-Tracker Assisted Frailty-Assessment Before Transcatheter Aortic Valve Implantation: Proof-of-Concept Study

Mach¹,

Watzal²,

Hasan³

et al. 2020

JMIR Mhealth Uhealth

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Background While transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic valve stenosis, wearable health-monitoring devices are gradually transforming digital patient care. Objective The aim of this study was to develop a simple, efficient, and economical method for preprocedural frailty assessment based on parameters measured by a wearable health-monitoring device. Methods In this prospective study, we analyzed data of 50 consecutive patients with mean (SD) age of 77.5 (5.1) years and a median (IQR) European system for cardiac operative risk evaluation (EuroSCORE) II of 3.3 (4.1) undergoing either transfemoral or transapical TAVR between 2017 and 2018. Every patient was fitted with a wrist-worn health-monitoring device (Garmin Vivosmart 3) for 1 week prior to the procedure. Twenty different parameters were measured, and threshold levels for the 3 most predictive categories (ie, step count, heart rate, and preprocedural stress) were calculated. Patients were assigned 1 point per category for exceeding the cut-off value and were then classified into 4 stages (no, borderline, moderate, and severe frailty). Furthermore, the FItness-tracker assisted Frailty-Assessment Score (FIFA score) was compared with the scores of the preprocedural gait speed category derived from the 6-minute walk test (GSC-6MWT) and the Edmonton Frail Scale classification (EFS-C). The primary study endpoint was hospital mortality. Results The overall preprocedural stress level (P=.02), minutes of high stress per day (P=.02), minutes of rest per day (P=.045), and daily heart rate maximum (P=.048) as single parameters were the strongest predictors of hospital mortality. When comparing the different frailty scores, the FIFA score demonstrated the greatest predictive power for hospital mortality (FIFA area under the curve [AUC] 0.844, CI 0.656-1.000; P=.048; GSC-6MWT AUC 0.671, CI 0.487-0.855; P=.42; EFS-C AUC 0.636, CI 0.254-1.000; P=.44). Conclusions This proof-of-concept study demonstrates the strong predictive performance of the FIFA score compared to that of the conventional frailty assessments.

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“…[29][30][31] Previous work on the perioperative use of EFS has been focused on its predictability of postoperative mortality and length of hospital stay, but little attention has been given to the exact EFS score that could help with risk stratification in the surgical patients. 11,32,33 Since EFS was developed and assessed by a group of Canadian geriatricians, the standard cut off value used to define frail and nonfrail patients may not be fully applicable when applying to the surgical patients in Asia when predicting postoperative outcomes. 19 Our work demonstrated for the first time that EFS score of 4 and above could give perioperative clinicians fair predictability of increased postoperative complication risk in the Asian patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Predictive Validity and Feasibility of Edmonton Frailty Scale in Identifying Postoperative Complications among Asian Elderly Patients A Prospective Observational Study

Hui

et al. 2019

Preprint

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Background Frailty is defined as diminished physiological reserve predisposing one to adverse outcomes when exposed to stressors. Currently, there is no standardized frailty assessment tool used perioperatively. Edmonton Frail Scale (EFS), which is validated for use by non-geriatricians and in selected surgical populations, is a candidate for this role. Scores ranging from “non-frail” (<=5 points), “vulnerable” (6<=n<=7 points) and “frail” (>=8 points). However, little evaluation of its use has been carried out in the Asians so far. The primary aim of this study is to assess if frailty measured by EFS is predictive of postoperative complications in elderly Asian patients undergoing elective major abdominal surgery. We also aim to assess the feasibility of implementing EFS as a standard tool in the outpatient preoperative assessment clinic setting. Methods This is a prospective observational study done among patients aged 70 years and above attended PAC in Singapore General Hospital prior to major abdominal surgery from December 2017 to September 2018. The Comprehensive Complication Index (CCI) and Postoperative Morbidity Survey (POMS) were used to assess their postoperative morbidity respectively. Patient’s acceptability of EFS was measured using the QQ-10 questionnaire and the inter-rater variability of EFS was also assessed using Bland Altman plot. Results EFS score was found to be a significant predictor of postoperative morbidity. (OR 1.35, p < 0.001) Each point increase in EFS score was associated with a 3 point increase in CCI score. (Coefficient b 2.944, p < 0.001) EFS score more than 4 has a fair predictability of early and 30-day postoperative complications. Feasibility study demonstrated an overall acceptance of the EFS among our patients with good inter-rater agreement. Conclusion These results show that EFS is able to predict postoperative complications in elderly Asian patients undergoing elective major abdominal surgery. It is also feasible to be incorporated as a standard assessment in the outpatient preoperative clinic setting.

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The Edmonton Frail Scale Improves the Prediction of 30-Day Mortality in Elderly Patients Undergoing Cardiac Surgery: A Prospective Observational Study

Cited by 42 publications

References 26 publications

Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

Assessment of predictive validity and feasibility of Edmonton Frail Scale in identifying postoperative complications among elderly patients: a prospective observational study

Fitness-Tracker Assisted Frailty-Assessment Before Transcatheter Aortic Valve Implantation: Proof-of-Concept Study

Assessment of Predictive Validity and Feasibility of Edmonton Frailty Scale in Identifying Postoperative Complications among Asian Elderly Patients A Prospective Observational Study

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