Frailty as a Predictor of Surgical Outcomes in Older Patients
| Autor: | Lara Devgan, Martin A. Makary, Dorry L. Segev, Jing Tian, Karen Bandeen-Roche, Ryan K. Takenaga, Dora Syin, Peter J. Pronovost, Linda P. Fried, Purvi Patel, Christine G. Holzmueller |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Frail Elderly Comorbidity Logistic regression Rate ratio Risk Assessment Postoperative Complications Predictive Value of Tests Risk Factors Outcome Assessment Health Care Humans Medicine Prospective Studies Elective surgery Prospective cohort study Geriatric Assessment Aged business.industry Incidence Odds ratio Perioperative Length of Stay medicine.disease Logistic Models Elective Surgical Procedures Area Under Curve Emergency medicine Physical therapy Female Surgery business Risk assessment |
| Zdroj: | Journal of the American College of Surgeons. 210:901-908 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/j.jamcollsurg.2010.01.028 |
| Popis: | Preoperative risk assessment is important yet inexact in older patients because physiologic reserves are difficult to measure. Frailty is thought to estimate physiologic reserves, although its use has not been evaluated in surgical patients. We designed a study to determine if frailty predicts surgical complications and enhances current perioperative risk models.We prospectively measured frailty in 594 patients (age 65 years or older) presenting to a university hospital for elective surgery between July 2005 and July 2006. Frailty was classified using a validated scale (0 to 5) that included weakness, weight loss, exhaustion, low physical activity, and slowed walking speed. Patients scoring 4 to 5 were classified as frail, 2 to 3 were intermediately frail, and 0 to 1 were nonfrail. Main outcomes measures were 30-day surgical complications, length of stay, and discharge disposition. Multiple logistic regression (complications and discharge) and negative binomial regression (length of stay) were done to analyze frailty and postoperative outcomes associations.Preoperative frailty was associated with an increased risk for postoperative complications (intermediately frail: odds ratio [OR] 2.06; 95% CI 1.18-3.60; frail: OR 2.54; 95% CI 1.12-5.77), length of stay (intermediately frail: incidence rate ratio 1.49; 95% CI 1.24-1.80; frail: incidence rate ratio 1.69; 95% CI 1.28-2.23), and discharge to a skilled or assisted-living facility after previously living at home (intermediately frail: OR 3.16; 95% CI 1.0-9.99; frail: OR 20.48; 95% CI 5.54-75.68). Frailty improved predictive power (p0.01) of each risk index (ie, American Society of Anesthesiologists, Lee, and Eagle scores).Frailty independently predicts postoperative complications, length of stay, and discharge to a skilled or assisted-living facility in older surgical patients and enhances conventional risk models. Assessing frailty using a standardized definition can help patients and physicians make more informed decisions. |
| Databáze: | OpenAIRE |
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