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BMC Geriatrics
Published in: BMC Geriatrics 1/2016

Open Access 01-12-2016 | Research Article

Frailty and post-operative outcomes in older surgical patients: a systematic review

Authors: Hui-Shan Lin, J. N. Watts, N. M. Peel, R. E. Hubbard

Published in: BMC Geriatrics | Issue 1/2016

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Abstract

Background

As the population ages, increasing numbers of older adults are undergoing surgery. Frailty is prevalent in older adults and may be a better predictor of post-operative morbidity and mortality than chronological age. The aim of this review was to examine the impact of frailty on adverse outcomes in the ‘older old’ and ‘oldest old’ surgical patients.

Methods

A systematic review was undertaken. Electronic databases from 2010 to 2015 were searched to identify articles which evaluated the relationship between frailty and post-operative outcomes in surgical populations with a mean age of 75 and older. Articles were excluded if they were in non-English languages or if frailty was measured using a single marker only. Demographic data, type of surgery performed, frailty measure and impact of frailty on adverse outcomes were extracted from the selected studies. Quality of the studies and risk of bias was assessed by the Epidemiological Appraisal Instrument.

Results

Twenty-three studies were selected for the review and they were assessed as medium to high quality. The mean age ranged from 75 to 87 years, and included patients undergoing cardiac, oncological, general, vascular and hip fracture surgeries. There were 21 different instruments used to measure frailty. Regardless of how frailty was measured, the strongest evidence in terms of numbers of studies, consistency of results and study quality was for associations between frailty and increased mortality at 30 days, 90 days and one year follow-up, post-operative complications and length of stay. A small number of studies reported on discharge to institutional care, functional decline and lower quality of life after surgery, and also found a significant association with frailty.

Conclusion

There was strong evidence that frailty in older-old and oldest-old surgical patients predicts post-operative mortality, complications, and prolonged length of stay. Frailty assessment may be a valuable tool in peri-operative assessment. It is possible that different frailty tools are best suited for different acuity and type of surgical patients. The association between frailty and return to pre-morbid function, discharge destination, and quality of life after surgery warrants further research.
Literature
1.
2.
3.
Australian Institute of Health and Welfare. Australian hospital statistics 2012–13. In: Health services series; no 54. Canberra: Australian Institute of Health and Welfare; 2014.
4.
Song X. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010;58(4):681–7.CrossRefPubMed
5.
Rockwood K, Howlett SE, MacKnight C, Beattie BL, Bergman H, Hebert R, et al. Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging. J Gerontol A Biol Sci Med Sci. 2004;59(12):1310–7.CrossRefPubMed
6.
Hubbard RE, Story DA. Does frailty lie in the eyes of the beholder? Heart Lung Circ. 2015;24(6):525–6.CrossRefPubMed
7.
de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104–14.CrossRefPubMed
8.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–156.CrossRefPubMed
9.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.CrossRefPubMedPubMedCentral
10.
Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62(7):722–7.CrossRefPubMed
11.
Singh I, Gallacher J, Davis K, Johansen A, Eeles E, Hubbard RE. Predictors of adverse outcomes on an acute geriatric rehabilitation ward. Age Ageing. 2012;41(2):242–6.CrossRefPubMed
12.
13.
Morley JE, Vellas B, Abellan van Kan G, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–7.
14.
Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM. In search of an integral conceptual definition of frailty: opinions of experts. J Am Med Dir Assoc. 2010;11(5):338–43.CrossRefPubMed
15.
Genaidy AM, Lemasters GK, Lockey J, Succop P, Deddens J, Sobeih T, et al. An epidemiological appraisal instrument - a tool for evaluation of epidemiological studies. Ergonomics. 2007;50(6):920–60.CrossRefPubMed
16.
West S, King V, Carey TS, Lohr KN, McKoy N, Sutton SF, et al. Systems to rate the strength of scientific evidence. Evidence Report/Technology Assessment No. 47 (Prepared by the Research Triangle Institute- University of North Carolina Evidence-based Practice Center under Contract No. 290-97-0011). Rockville, MD: Agency for Healthcare Research and Quality, 2002. AHRQ Publication No. 02-E016.
17.
Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, et al. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes. 2012;5(2):222–8.CrossRefPubMed
18.
Green P, Woglom AE, Genereux P, Daneault B, Paradis JM, Schnell S, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC Cardiovasc Interv. 2012;5(9):974–81.CrossRefPubMedPubMedCentral
19.
Kamga M, Boland B, Cornette P, Beeckmans M, De Meester C, Chenu P, et al. Impact of frailty scores on outcome of octogenarian patients undergoing transcatheter aortic valve implantation. Acta Cardiol. 2013;68(6):599–606.PubMed
20.
Schoenenberger AW, Stortecky S, Neumann S, Moser A, Jüni P, Carrel T, et al. Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI). Eur Heart J. 2013;34(9):684–92.CrossRefPubMed
21.
Stortecky S, Schoenenberger AW, Moser A, Kalesan B, Juni P, Carrel T, et al. Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2012;5(5):489–96.CrossRefPubMed
22.
Sundermann S, Dademasch A, Praetorius J, Kempfert J, Dewey T, Falk V, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg. 2011;39(1):33–7.CrossRefPubMed
23.
Sundermann S, Dademasch A, Rastan A, Praetorius J, Rodriguez H, Walther T, et al. One-year follow-up of patients undergoing elective cardiac surgery assessed with the Comprehensive Assessment of Frailty test and its simplified form. Interact Cardiovasc Thorac Surg. 2011;13(2):119–23. discussion 123.CrossRefPubMed
24.
Sundermann SH, Dademasch A, Seifert B, Rodriguez Cetina Biefer H, Emmert MY, Walther T, et al. Frailty is a predictor of short- and mid-term mortality after elective cardiac surgery independently of age. Interact Cardiovasc Thorac Surg. 2014;18(5):580–5.CrossRefPubMed
25.
Kristjansson SR, Nesbakken A, Jordhoy MS, Skovlund E, Audisio RA, Johannessen HO, et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol. 2010;76(3):208–17.CrossRefPubMed
26.
Kristjansson SR, Rønning B, Hurria A, Skovlund E, Jordhøy MS, Nesbakken A, et al. A comparison of two pre-operative frailty measures in older surgical cancer patients. J Geriatr Oncol. 2012;3(1):1–7.CrossRef
27.
Ommundsen N, Wyller TB, Nesbakken A, Jordhoy MS, Bakka A, Skovlund E, et al. Frailty is an independent predictor of survival in older patients with colorectal cancer. Oncologist. 2014;19(12):1268–75.CrossRefPubMedPubMedCentral
28.
Rønning B, Wyller TB, Jordhøy MS, Nesbakken A, Bakka A, Seljeflot I, et al. Frailty indicators and functional status in older patients after colorectal cancer surgery. J Geriatr Oncol. 2014;5(1):26–32.CrossRefPubMed
29.
Tan KY, Kawamura YJ, Tokomitsu A, Tang T. Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg. 2012;204(2):139–43.CrossRefPubMed
30.
Hewitt J, Moug SJ, Middleton M, Chakrabarti M, Stechman MJ, McCarthy K. Prevalence of frailty and its association with mortality in general surgery. Am J Surg. 2015;209(2):254–9.CrossRefPubMed
31.
Kenig J, Zychiewicz B, Olszewska U, Barczynski M, Nowak W. Six screening instruments for frailty in older patients qualified for emergency abdominal surgery. Arch Gerontol Geriatr. 2015;61:437–42.CrossRefPubMed
32.
Ambler GK, Brooks DE, Al Zuhir N, Ali A, Gohel MS, Hayes PD, et al. Effect of frailty on short- and mid-term outcomes in vascular surgical patients. Br J Surg. 2015;102(6):638–45.CrossRefPubMed
33.
Kim SW, Han HS, Jung HW, Kim KI, Hwang DW, Kang SB, et al. Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surgery. 2014;149(7):633–40.CrossRefPubMed
34.
Partridge JSL, Fuller M, Harari D, Taylor PR, Martin FC, Dhesi JK. Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes. Int J Surg. 2015;18:57–63.CrossRefPubMed
35.
Kistler EA, Nicholas JA, Kates SL, Friedman SM. Frailty and Short-Term Outcomes in Patients With Hip Fracture. Geriatr Orthop Surg Rehabil. 2015;6(3):209–14.CrossRefPubMedPubMedCentral
36.
Krishnan M, Beck S, Havelock W, Eeles E, Hubbard RE, Johansen A. Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results. Age Ageing. 2014;43(1):122–6.CrossRefPubMed
37.
Neuman HB, Weiss JM, Leverson G, O'Connor ES, Greenblatt DY, Loconte NK, et al. Predictors of short-term postoperative survival after elective colectomy in colon cancer patients >/= 80 years of age. Ann Surg Oncol. 2013;20(5):1427–35.CrossRefPubMedPubMedCentral
38.
Patel KV, Brennan KL, Brennan ML, Jupiter DC, Shar A, Davis ML. Association of a modified frailty index with mortality after femoral neck fracture in patients aged 60 years and older. Clin Orthop Relat Res. 2014;472(3):1010–7.CrossRefPubMed
39.
Green P, Arnold SV, Cohen DJ, Kirtane AJ, Kodali SK, Brown DL, et al. Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER trial). Am J Cardiol. 2015;116(2):264–9.CrossRefPubMedPubMedCentral
40.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral
41.
Beggs T, Sepehri A, Szwajcer A, Tangri N, Arora RC. Frailty and perioperative outcomes: a narrative review. Can J Anaesth. 2015;62(2):143–57.CrossRefPubMed
42.
Feng MA, McMillan DT, Crowell K, Muss H, Nielsen ME, Smith AB. Geriatric assessment in surgical oncology: a systematic review. J Surg Res. 2015;193(1):265–72.CrossRefPubMed
43.
Sepehri A, Beggs T, Hassan A, Rigatto C, Shaw-Daigle C, Tangri N, et al. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg. 2014;148(6):3110–7.CrossRefPubMed
44.
Dunne MJ, Abah U, Scarci M. Frailty assessment in thoracic surgery. Interact Cardiovasc Thorac Surg. 2014;18(5):667–70.CrossRefPubMed
45.
Wong CY, Green P, Williams M. Decision-making in transcatheter aortic valve replacement: the impact of frailty in older adults with aortic stenosis. Expert Rev Cardiovasc Ther. 2013;11(6):761–72.CrossRefPubMed
46.
Bagnall NM, Faiz O, Darzi A, Athanasiou T. What is the utility of preoperative frailty assessment for risk stratification in cardiac surgery? Interact Cardiovasc Thorac Surg. 2013;17(2):398–402.CrossRefPubMedPubMedCentral
Metadata
Title
Frailty and post-operative outcomes in older surgical patients: a systematic review
Authors
Hui-Shan Lin
J. N. Watts
N. M. Peel
R. E. Hubbard
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2016
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-016-0329-8

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