Frailty as a predictor of surgical outcomes in older patients
Abstract
BACKGROUND: 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. STUDY DESIGN: 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. RESULTS: 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 (p < 0.01) of each risk index (ie, American Society of Anesthesiologists, Lee, and Eagle scores). CONCLUSIONS: 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.
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Many studies addressing perioperative outcomes and frailty, including in gynecologic surgery, are retrospective in nature or database driven.
“Many studies--including those looking at gynecologic surgery--addressing perioperative outcomes and frailty are retrospective in nature or database driven leaving opportunity for further understanding the impact of frailty on gynecologic surgery outcomes in prospective surgical trials.7–16”
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- Authors
- Makary, M. A., Segev, D. L., Pronovost, P. J., Syin, D., Bandeen-Roche, K., Patel, P., Takenaga, R., Devgan, L., Holzmueller, C. G., Tian, J., & Fried, L. P.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Makary, Martin A.
- ORCID
- Venue
- Journal of the American College of Surgeons
- Published
- 2010-06
- Volume
- 210
- Issue
- 6
- Pages
- 901-908
- ISSN
- 1072-7515 (ISSN-L)
- OpenAlex
- W2107640783
- Cited by
- 2,184
- References
- 6
- Citations by year
- 2026: 159 · 2025: 113 · 2024: 126 · 2023: 138 · 2022: 135 · 2021: 161 · 2020: 181 · 2019: 193 · 2018: 161 · 2017: 195 · 2016: 175 · 2015: 135 · 2014: 114 · 2013: 81 · 2012: 72
- FWCI
- 24.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American College of Surgeons (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r37ag019905-10)
- National Institute on Aging (R37-AG019905, P30AG021334)
- National Center for Research Resources (T32RR023253)
- 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 › Surgery › Hip and Femur Fractures
- Keywords
- frailty, older surgical patients, postoperative complications, preoperative risk assessment, length of hospital stay, discharge disposition, frailty index, physiological reserve
- MeSH terms
- Aged, Female, Humans, Length of Stay, Male, Postoperative Complications, Predictive Value of Tests, Prospective Studies, Risk Factors, Geriatric Assessment, Comorbidity, Incidence, Logistic Models, Frail Elderly, Outcome Assessment, Health Care, Elective Surgical Procedures, Risk Assessment, Area Under Curve
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