Assessing a patient’s level of frailty before an operation can provide important insight into which individuals might develop postoperative complications.
“For a long time, frailty was overlooked,” said Felix Balzer, MD, MSc, PhD, in the Department of Anesthesiology and Intensive Care Medicine at Charite Universitatsmedizin Berlin, in Germany. “Today, we know that frail patients are especially vulnerable to stresses in the preoperative context.”
Yet, although frailty assessments are being used increasingly to determine preoperative risk stratification, there are few data on the relationship between frailty and postoperative complications.
For their study, Dr. Balzer and his colleagues conducted a review of patients 65 years of age or older who were seen in the outpatient anesthesiology department for elective surgery from Jan. 14, 2016 through April 30, 2016. A frailty assessment was administered to 196 patients, consisting of a grip strength measurement, timed up-and-go test, a hemoglobin test, and a body mass index or serum albumin level as a test for malnutrition (Table).
The patients were assigned 1 point for each pathologic test result. Patients scoring 0 to 1 point were designated “non-frail” (reference group; 68%); those with 2 points were “pre-frail” (23%) and those with 3 to 4 points were “frail” (9%). Postoperative complications were analyzed via ICD-10 diagnosis codes, and European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA) guidelines were used to estimate operative risk.
Frailty a Red Flag
Reviewing the data, Dr. Balzer and his team found that the incidence of complications following the procedure—specifically delirium, cardiac or cerebral ischemia, and/or pneumonia—was significantly higher in patients in the pre-frail (24.4%; n=11) and frail groups (52.9%; n=9) than in the reference group (17.2%; n=9) (P=0.005; Figure).
According to Dr. Balzer, the findings should reinforce the benefit of preoperative frailty assessments in order to plan for, and help prevent, postoperative complications. “We believe frailty assessment should be implemented in every preoperative assessment in anesthesiology.”
Dr. Balzer said his aim is to continue this area of study to discover further information regarding how a patient’s preoperative condition may signal issues that might lie ahead. “Our next goal is to work on a more detailed approach to see how we can predict postoperative outcome more precisely.”