Frailty Screening Before Surgery Reduces Risk of Death

Widespread screening of patients preoperatively to identify frailty and take appropriate measures can improve surgical outcomes, according to a new study.

Researchers at the University of Pittsburgh (PITT; PA, USA) and the Veterans Affairs (VA) Pittsburgh Healthcare System (PA, USA) conducted a study in 9,153 surgical patients (average age 60 years) to examine the impact of a frailty screening initiative (FSI) on death and complication rates. The researchers compared surgical outcomes of major, elective, noncardiac surgery patients treated both before and after implementation of the FSI, with preoperative frailty assessed using a 14-item risk analysis index (RAI) questionnaire.

The medical records of all frail patients were flagged for administrative review before the scheduled operation. On the basis of the review, clinicians from surgery, anesthesia, critical care, and palliative care were notified of the patient's frailty and associated surgical risks; if indicated, perioperative plans were modified based on team input. The results showed that overall 30-day mortality decreased from 1.6% to 0.7% after FSI implementation, with improvement greatest among frail patients (12.2% to 3.8%), although mortality rates also decreased among robust patients (1.2% to 0.3%). The study was published on November 30, 2016, in JAMA Surgery.

“The ultimate cause of the survival benefit is likely multifactorial, including changes in preoperative decision-making, intraoperative management, and postoperative rescue,” concluded lead author Daniel Hall, MD, MDiv, MHSc, and colleagues. “This study reveals the feasibility of facility-wide frailty screening in elective surgical populations; it also suggests the potential to improve postoperative survival among the frail through systematic administrative screening, review, and optimization of perioperative plans.”

Frailty is theoretically defined as a clinically recognizable state of increased vulnerability, resulting from aging-associated decline in reserve and function across multiple physiologic systems, so that the ability to cope with everyday or acute stressors is compromised. In the absence of a gold standard, frailty has been operationally defined as meeting three out of five phenotypic criteria: low grip strength, low energy, slowed waking speed, low physical activity, and/or unintentional weight loss.

Related Links:
University of Pittsburgh
Veterans Affairs Pittsburgh Healthcare System