Redefining Geriatric Preoperative Assessment Using Frailty, Disability and Co-Morbidity
Abstract
Objectives (1) Determine the relationship of geriatric assessment markers to 6-month postoperative mortality in elderly patients. (2) Create a clinical prediction rule using geriatric markers from preoperative assessment. Background Geriatric surgery patients have unique physiologic vulnerability requiring preoperative assessment beyond the traditional evaluation of older adults. The constellation of frailty, disability and comorbidity predict poor outcomes in elderly hospitalized patients. Methods Prospectively, subjects > or =65 years undergoing a major operation requiring postoperative intensive care unit admission were enrolled. Preoperative geriatric assessments included: Mini-Cog Test (cognition), albumin, having fallen in the past 6-months, hematocrit, Katz Score (function), and Charlson Index (comorbidities). Outcome measures included 6-month mortality (primary) and postdischarge institutionalization (secondary). Results One hundred ten subjects (age 74 +/- 6 years) were studied. Six-month mortality was 15% (16/110). Preoperative markers related to 6-month mortality included: impaired cognition (P Conclusions Geriatric assessment markers for frailty, disability and comorbidity predict 6-month postoperative mortality and postdischarge institutionalization. The preoperative presence of > or =4 geriatric-specific markers has high sensitivity and specificity for 6-month mortality. Preoperative assessment using geriatric-specific markers is a substantial paradigm shift fro…
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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.”
Frailty was measured using the Robinson Frailty Index.
“Frailty was measured using the Robinson Frailty Index.”
A predictive tool using six deficit-driven measures of frailty was developed to predict mortality after major surgery in older adults.
“A predictive tool using six deficit-driven measures of frailty (Mini-Cog score, validated comorbidity index, functional disability, history of falls, preoperative serum albumin, and hematocrit) was developed to predict mortality after major surgery in older adults.19”
Coexisting comorbidities can lead to worse treatment outcomes.
“Coexisting co-morbidities, also common in women with urinary incontinence, can lead to worse treatment outcomes (19–21)”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [19]
Recent studies suggest coexisting disabilities are linked to worse functional outcomes after surgery.
“Recent studies suggest that the presence of coexisting disabilities is associated with worse functional outcomes following surgery.(19, 20)”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [19]
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Validity and reliability of the Edmonton Frail Scale
Rolfson, D. B., Majumdar, S. R., Tsuyuki, R. T., Tahir, A., & Rockwood, K. (2006) · Age and Ageing · doi:10.1093/ageing/afl041 · Cited by 1,643 · cited 3× · see citing works
“(3) Polypharmacy–The number of outpatient medications an individual took within 30 days of the operation was recorded as a surrogate to represent burden of comorbidities.(11,12)”
BackgroundMethodOperationalizing a frailty index from a standardized comprehensive geriatric assessment
Jones, D. M., Song, X., & Rockwood, K. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52521.x · Cited by 605 · see citing works
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Frailty Assessment in the Cardiovascular Care of Older Adults
Afilalo, J., Alexander, K. P., Mack, M. J., Maurer, M. S., Green, P., Allen, L. A., Popma, J. J., Ferrucci, L., & Forman, D. E. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.09.070 · Cited by 1,173 · see citing works
The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis
Muscedere, J., Waters, B., Varambally, A., Bagshaw, S. M., Boyd, J. G., Maslove, D., Sibley, S., & Rockwood, K. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4867-0 · Cited by 827 · see citing works
Simple frailty score predicts postoperative complications across surgical specialties
Robinson, T. N., Wu, D. S., Pointer, L., Dunn, C. L., Cleveland, J. C., & Moss, M. (2013) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2013.03.012 · Cited by 513 · see citing works
Self-citationFrailty for Surgeons: Review of a National Institute on Aging Conference on Frailty for Specialists
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Self-citationMotor Subtypes of Postoperative Delirium in Older Adults
Robinson, T. N. (2011) · Archives of Surgery · doi:10.1001/archsurg.2011.14 · Cited by 250 · see citing works
Self-citationRobinson, T. N., Wu, D. S., Sauaia, A., Dunn, C. L., Stevens-Lapsley, J. E., Moss, M., Stiegmann, G. V., Gajdos, C., Cleveland, J. C., & Inouye, S. K. (2013) · Annals of Surgery · doi:10.1097/sla.0b013e3182a4e96c · Cited by 199 · see citing works
Self-citationSchmidt, M., Eckardt, R., Scholtz, K., Neuner, B., von Dossow-Hanfstingl, V., Sehouli, J., Stief, C. G., Wernecke, K.-D., Spies, C. D., & PERATECS Group (2015) · PLOS ONE · doi:10.1371/journal.pone.0137824 · Cited by 87 · see citing works
Functional Status and Postoperative Morbidity in Older Women with Prolapse
Greer, J. A., Northington, G. M., Harvie, H. S., Segal, S., Johnson, J. C., & Arya, L. A. (2013) · Journal of Urology · doi:10.1016/j.juro.2013.03.004 · Cited by 33 · see citing works
Greer, J. A., Xu, R., Propert, K. J., & Arya, L. A. (2015) · Neurourology and Urodynamics · doi:10.1002/nau.22615 · Cited by 24 · see citing works
“Recent studies suggest that the presence of coexisting disabilities is associated with worse functional outcomes following surgery.(19,20) When planning treatment options for women with urinary incontinence, surgeons need to be cognizant of the possibility of worse outcomes in women with urinary incontinence when co-e…”
BackgroundOutcomes of Surgery for Stress Urinary Incontinence in the Older Woman
Ellington, D. R., Erekson, E. A., & Richter, H. E. (2015) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2015.06.006 · Cited by 22 · see citing works
Erekson, E., Menefee, S. A., Whitworth, R., Gizlice, S., Zyczynski, H. M., Rahn, D. D., Amundsen, C. L., Sung, V. W., Arya, L. A., Ferrando, C. A., et al. (2026) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2025.11.002
- Authors
- Robinson, T. N., Eiseman, B., Wallace, J. I., Church, S. D., McFann, K. K., Pfister, S. M., Sharp, T. J., & Moss, M.
- Affiliations
- Denver VA Medical Center (US)
- University of Colorado Anschutz (US)
- Corresponding author
- Robinson, Thomas N.
- Eiseman, Ben
- Church, Skotti D.
- ORCID
- McFann, Kim K.
- Venue
- Annals of Surgery
- Published
- 2009-09
- Volume
- 250
- Issue
- 3
- Pages
- 449-455
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W2045810535
- Cited by
- 543
- References
- 3
- Citations by year
- 2026: 16 · 2025: 14 · 2024: 22 · 2023: 25 · 2022: 31 · 2021: 36 · 2020: 36 · 2019: 43 · 2018: 34 · 2017: 44 · 2016: 53 · 2015: 34 · 2014: 58 · 2013: 27 · 2012: 35
- FWCI
- 16.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- 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 › Surgery › Hip and Femur Fractures
- Keywords
- frailty, disability, comorbidities, postoperative mortality, older surgical patients, functional dependence, cognitive impairment, falls, albumin, anemia, clinical prediction rules, Charlson Comorbidity Index, Mini-Cog, Katz Index
- MeSH terms
- Aged, Aged, 80 and over, Disability Evaluation, Female, Humans, Male, Predictive Value of Tests, Risk Factors, Sensitivity and Specificity, Surgical Procedures, Operative, Geriatric Assessment, Comorbidity, Logistic Models, Frail Elderly
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