M. M. Mrdutt1, B. Robinson1, E. Bird1, H. Papaconstantinou1, C. Isbell1 1Baylor Scott & White Medical Center-Temple,Department Of Surgery,Temple, TEXAS, USA
Introduction: Frailty is a measure of physiologic reserve and an emerging metric for risk stratification. Ideally frailty assessment would be objective, easily administered during a preoperative assessment, and offer timely information with regard to postoperative complication risk. We examined the correlation of frailty with postoperative outcomes following major abdominal and thoracic surgery to determine its potential as a risk-assessment tool.
Methods: Frailty was prospectively measured at a single institution in all elective surgery patients using the Modified Hopkins Frailty Score. Frailty classification—low (0), intermediate (1-2), or high (≥3)—was calculated based on shrinking (unintentional recent weight loss 10 pounds or greater in the last year), handgrip strength, hemoglobin, and ASA classification. Demographics and surgical outcomes were obtained from institutional procedure-targeted National Surgical Quality Improvement Program (NSQIP) data for major abdominal (esophagectomy, pancreatectomy, hepatectomy, colectomy, proctectomy, nephrectomy, cystectomy) and thoracic (pulmonary resection) procedures January 2016-June 2017. Outcomes included any NSQIP complication, readmission, unplanned reoperation or mortality within 30 days, along with discharge location and prolonged length of stay (> 75th percentile of 2015 NSQIP national average). Logistic regression was performed accounting for demographics, comorbidities and frailty for each complication.
Results: Of the 548 patients identified, 426 (77.8%) had a complete frailty evaluation. Cases included pulmonary resections (17.3%) and abdominal procedures (82.7%); the majority of patients were classified as intermediate (76.5%) or high (10.3%) frailty. Incidence of any NSQIP complication, readmission and discharge to a facility correlated with frailty classification in univariate analysis (Figure, p<0.05). Logistic regression demonstrated an increased odds ratio (OR) with increasing frailty for any NSQIP complication (intermediate OR 3.6, high OR 8.9), readmission (intermediate OR 7.5, high OR 15.3) and discharge to facility (intermediate OR 3.3, high OR 10). There was no significant association with unplanned reoperation, prolonged LOS or mortality.
Conclusion: Higher frailty correlates with increased postoperative complications, readmission and discharge location. These findings provide external validation for the Modified Hopkins Score in major non-cardiac elective cases and provide a link between postoperative morbidity and preoperative frailty. Preoperative frailty assessment should contribute to perioperative patient optimization and care strategies, specifically in high risk procedures such as those captured by NSQIP procedure targeted cases.
