Evidence of Frailty Before Surgery May Predict Surgical Risk

Jennifer Garcia

September 25, 2013

A new prospective study shows that the Hopkins Frailty Score (HFS) can help predict preoperatively which patients are at greater risk of developing complications after surgery. These results were published online June 27 and in the October issue of the Journal of the American College of Surgery.

The study, led by Kenneth Ogan, MD, from Emory University School of Medicine, Atlanta, Georgia, used an established preoperative assessment tool, the HFS, in conjunction with patient questionnaires, clinical evaluations of performance, and routine preoperative serum biochemical measurements to evaluate 189 patients for a 30-day period after general, oncologic, and urologic surgery.

The researchers found that patients were more likely to experience postoperative complications if they scored "intermediately frail" or "frail" on the HFS (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.05 - 4.08; P = .036). HFS measures of preoperative shrinking or weight loss (P = .025), as well as preoperative hemoglobin (P = .004), were found to be statistically significant predictors of a postoperative complication at 30 days. There was no difference between patients who underwent minimally invasive surgical procedures vs open surgery.

"Based on our results, the Hopkins Frailty Score alone appears to maintain a very robust predictive power in preoperatively identifying patients at risk for postoperative complications," write Dr. Ogan and colleagues.

The authors acknowledge study limitations such as the small study size and the short duration of follow-up. In addition, the effect of preoperative interventions that may have reduced risk was also not evaluated.

"This assessment tool may allow surgeons to better risk-stratify patients, and ultimately provide interventions in the preoperative period to mitigate poor surgical outcomes," the study authors conclude.

In an invited commentary, Tomas L. Griebling, MD, MPH, from Kansas City, Kansas, notes: "The overall results [by Ogan and colleagues] indicated that rates of frailty increased with age, and the aggregate frailty index score was predictive of outcomes."

"The utility of frailty indices, biomarkers, and other predictive measures offers an important and objective method of assessment in this often complex population," he noted.

The authors and editorialist have disclosed no relevant financial relationships.

J Am Coll Surg. 2013;217:665-671. Abstract

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