Frailty Phenotypes and Relations With Surgical Outcomes

Autor: Anshuman Sharma, Daniel L. Helsten, Arbi Ben Abdallah, Sherry L. McKinnon, Michael S. Avidan, Troy S. Wildes, Furqaan Sadiq, Lawrence M. Scheier, Vanessa L. Kronzer
Rok vydání: 2018
Předmět:
Adult
Male
Gerontology
Activities of daily living
Frail Elderly
Emotions
Nutritional Status
Patient Readmission
Risk Assessment
Severity of Illness Index
Article
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Activities of Daily Living
Severity of illness
Humans
Medicine
Patient Reported Outcome Measures
Registries
030212 general & internal medicine
Social Behavior
Geriatric Assessment
Aged
Retrospective Studies
Frailty
business.industry
Age Factors
Geriatric assessment
Retrospective cohort study
Middle Aged
Mental health
Phenotype
Latent class model
Mental Health
Treatment Outcome
Anesthesiology and Pain Medicine
Physical Fitness
Surgical Procedures
Operative
Quality of Life
Female
Observational study
business
030217 neurology & neurosurgery
Zdroj: Anesthesia & Analgesia. 127:1017-1027
ISSN: 0003-2999
Popis: BACKGROUND: Frailty is an important concept in the care of older adults although controversy remains regarding its defining features and clinical utility. Both the Fried phenotype and the Rockwood deficit accumulation approaches cast frailty as a “burden” without exploring the relative salience of its cardinal markers and their relevance to the patient. New multifactorial perspectives require a reliable assessment of frailty that can validly predict postoperative health outcomes. METHODS: In a retrospective study of 2,828 unselected surgical patients, we used item response theory to examine the ability of 32 heterogeneous markers capturing limitations in physical, functional, emotional, and social activity domains to indicate severity of frailty as a latent continuum. Eighteen markers efficiently indicated frailty severity and were then subject to latent class analysis to derive discrete phenotypes. Next, we validated the obtained frailty phenotypes against patient-reported 30-day postoperative outcomes using multivariable logistic regression. Models were adjusted for demographics, comorbidity, type and duration of surgery, and cigarette and alcohol consumption. RESULTS: The 18 markers provided psychometric evidence of a single reliable continuum of frailty severity. Latent class analyses produced three distinct subtypes, based on patients’ endorsement probabilities of the frailty indicators: Not Frail (49.7%), Moderately Frail (33.5%), and Severely Frail (16.7%). Unlike the Moderate class, Severely Frail endorsed emotional health problems in addition to physical burdens and functional limitations. Models adjusting for age, sex, type of anesthesia, as well as intra-operative factors indicated that Severely Frail (OR =1.89, 95% CI =1.42 to 2.50) and Moderately Frail patients (OR =1.31, 95% CI =1.03 to 1.67) both had higher odds of experiencing postoperative complications compared to Not Frail patients. In a three-way comparison, a higher proportion of Severely Frail patients (10.7%) reported poorer quality of life after surgery compared to Moderately Frail (9.2%) and Not Frail (8.3%) patients (p
Databáze: OpenAIRE
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