Preoperative Frailty screening predicts postoperative outcomes in older surgical patients

Canada: A study published in Anesthesia and Analgesia under Geriatric Anesthesia has concluded that frailty, measured by the FRAIL scale, is associated with mortality at 30 days and six months in older surgical patients. It is also tied to increased postoperative complications and postoperative delirium.

The study highlighted that a FRAIL scale is valuable as it could screen older surgical patients for frailty.

The FRAIL (fatigue, resistance, ambulation, illness, and weight loss) scale was conceptualized in 2008 by the International Association of Nutrition and Aging task force. It is based on the Fried frailty phenotype, including loss of weight, self-reported exhaustion, grip strength, slow walking speed, and low physical activity.

The assessment takes approximately 10 minutes, and the FRAIL scale is a 5-item, self-reported questionnaire using yes/no questions, thereby allowing rapid identification of frail and prefrail individuals.

The frailty is assessed based on five components: fatigue, resistance (ability to climb stairs), ambulation (ability to walk a certain distance), illness, and weight loss. Each component is scored with 1 or 0 points based on presence or absence. (Score 0: non-frail, 1 to 2: prefrail, 3 to 5: frailty).

Increased frailty is significantly associated with higher mortality risk in community-dwelling adults. However, there needs to be more data on the association between the FRAIL scale and mortality and postoperative outcomes in older surgical patients.

Considering this, a systematic review and meta-analysis were conducted by a team of researchers led by Gong, Selena BhSc from the Institute of Medical Science and the Department of Anesthesiology and Pain Medicine at Women's College Hospital from the University of Toronto, Canada, to determine the given question:

As assessed by the FRAIL scale, is frailty associated with mortality and postoperative outcomes in older surgical patients?

The postoperative outcomes included mortality, complications, delirium, length of stay (LOS), and functional and cognitive recovery.

The study points are:

• A systemic review and meta-analysis were conducted. The databases searched were Medline, Medline ePubs/In-process citations, Embase, APA, PsycInfo, Ovid Emcare Nursing, CINAHL EbscoHost, the Web of Science and Scopus.
• The studies identified using the FRAIL scale in surgical patients.
• The study reported mortality and postoperative outcomes like postoperative complications, postoperative delirium, length of stay, and functional recovery.
• 18 studies were included
• There were 4479 patients.
• Frailty was reported using the FRAIL score.
• There was a higher odd of mortality, OR for 30-day and 6-month mortality was 6.62 and 2.97
• There were higher odds of postoperative complication (OR, 3.11) and postoperative delirium (OR, 2.65).

The researchers said that the FRAIL scale is a valuable tool for preoperative screening for the frailty of older adults before surgery.

The co-researcher mentioned FRAIL scale had been used since 2012 in community settings, and the first study was identified in 2017.

Our findings align with studies using the FRAIL scale in the community. In middle-aged women, frailty was correlated with increased disability, death, and depression.

Frailty was significantly associated with mortality when the FRAIL scale was used as a diagnostic screening tool. Frail patients had a 2.5-fold increased risk of postoperative complications (cardiovascular, respiratory, infectious, renal failure ) and a 2.4-fold higher risk of postoperative delirium when compared to non-frail patients.

In our SRMA, we found that the prevalence of frailty was 30% in the surgical population, which is higher than in the community-dwelling population. They said.

Further reading:

Gong, Selena BhSc et al. Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis. Anesthesia & Analgesia: November 29, 2022.