Simple frailty score predicts postoperative complications across surgical specialties
Open accessAbstract
Background Our purpose was to determine the relationship between preoperative frailty and the occurrence of postoperative complications after colorectal and cardiac operations.Methods Patients 65 years or older undergoing elective colorectal or cardiac surgery were enrolled. Seven baseline frailty traits were measured preoperatively: Katz score less than or equal to 5, Timed Up and Go test greater than or equal to 15 seconds, Charlson Index greater than or equal to 3, anemia less than 35%, Mini-Cog score less than or equal to 3, albumin less than 3.4 g/dL, and 1 or more falls within 6 months. Patients were categorized by the number of positive traits as follows: nonfrail: 0 to 1 traits, prefrail: 2 to 3 traits, and frail: 4 or more traits.Results Two hundred one subjects (age 74 ± 6 years) were studied. Preoperative frailty was associated with increased postoperative complications after colorectal (nonfrail: 21%, prefrail: 40%, frail: 58%; P = .016) and cardiac operations (nonfrail: 17%, prefrail: 28%, frail: 56%; P < .001). This finding in both groups was independent of advancing age. Frail individuals in both groups had longer hospital stays and higher 30-day readmission rates. Receiver operating characteristic curves examining frailty's ability to forecast complications were colorectal (.702, P = .004) and cardiac (.711, P < .001).Conclusions A simple preoperative frailty score defines older adults at higher risk for postoperative complications across surgical specialties.
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The study population had a lower percentage of overall frailty and fewer composite frailty measures than previously published prospectively studied surgical populations with frailty and a larger dataset of claims-based frailty indexes.
“The current study population had both a lower percentage of overall frailty and fewer composite frailty measures than previously published prospectively studied surgical populations with frailty and a larger dataset of claims-based frailty indexes.”
From Outcomes by frailty and mobility in older patients undergoing major urogynecologic surgery: a planned supplementary study of the apical suspension repair for vault prolapse in a three-arm randomized (ASPIRe) trial (2026) · cites this paper as [20]
The Results report 28% frailty among 201 surgical patients, and the Methods describe seven preoperative frailty characteristics, supporting the paper as an example of a previously studied surgical population with a composite frailty measure (page unavailable). The paper does not establish that the citing study had a lower frailty percentage or fewer measures, and it does not provide the claimed comparison with larger claims-based frailty-index datasets. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThis tool combined with the TUG test was found to predict postoperative complications better than standard risk-adjusted calculators across surgical specialties.
“This tool combined with the Timed Up and Go (TUG) test was found to predict postoperative complications better than standard risk-adjusted calculators across surgical specialties.20,21”
From Outcomes by frailty and mobility in older patients undergoing major urogynecologic surgery: a planned supplementary study of the apical suspension repair for vault prolapse in a three-arm randomized (ASPIRe) trial (2026) · cites this paper as [20]
The Methods (page unavailable) include the Timed Up-and-Go test as one of seven traits in the frailty score, and the Results report that the score predicted complications in colorectal and cardiac surgery patients. The paper compares its predictive performance with a null hypothesis, not with standard risk-adjusted calculators; it also does not test a separate tool combined with TUG. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFrailty was measured using the Robinson Frailty Index.
“Frailty was measured using the Robinson Frailty Index.”
These prospective cohort studies were performed at Veteran's Administration hospitals in a predominantly male population.
“However, these prospective cohort studies were performed at Veteran’s Administration hospitals in a predominantly male population.”
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- Authors
- Robinson, T. N., Wu, D. S., Pointer, L., Dunn, C. L., Cleveland, J. C., & Moss, M.
- Affiliations
- Denver VA Medical Center (US)
- University of Colorado Anschutz (US)
- Corresponding author
- Robinson, Thomas N.
- Venue
- The American Journal of Surgery
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 206
- Issue
- 4
- Pages
- 544-550
- ISSN
- 0002-9610 (ISSN-L)
- PMC
- PMC3788864
- OpenAlex
- W2154467062
- Semantic Scholar
- a727e37222039387bda0b9af689322fa73c11e91
- Cited by
- 513
- References
- 30
- Citations by year
- 2026: 19 · 2025: 24 · 2024: 36 · 2023: 41 · 2022: 34 · 2021: 47 · 2020: 66 · 2019: 49 · 2018: 40 · 2017: 50 · 2016: 48 · 2015: 31 · 2014: 27
- FWCI
- 16.32
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The American Journal of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (K23AG034632)
- National Heart, Lung, and Blood Institute (K24HL089223)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- preoperative frailty, frailty score, postoperative complications, colorectal surgery, cardiac surgery, older adults, preoperative assessment, length of hospital stay, 30-day readmission, fall history, anemia, albumin, cognitive impairment
- MeSH terms
- Aged, Colon, Female, Humans, Length of Stay, Male, Patient Readmission, Postoperative Complications, Prospective Studies, Rectum, ROC Curve, Cardiovascular Surgical Procedures, Digestive System Surgical Procedures, Geriatric Assessment, Logistic Models, Frail Elderly, Risk Assessment
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