For Older Adults, Complex Frailty Score Predicts Post-Op Outcomes
More than half of all operations are performed on patients 65 years and older in the United States. Frail elderly patients who undergo surgery are more likely to have postoperative complications. But tools to estimate operative risk have their limitations because they often focus on a single organ system or solitary event. In geriatric medicine, the comprehensive geriatric assessment (CGA) is widely used to detect disabilities and conditions associated with frailty.
Sun-wook Kim, M.D., of the Seoul National University College of Medicine, Korea and colleagues set out to develop a multidimensional frailty score model aimed at predicting unfavorable outcomes after surgery in older adults using results of the CGA, other patient characteristics, and laboratory variables. a study published online on May 7th 2014 in JAMA Surgery.
The authors enrolled 275 patients 65 and older who were undergoing intermediate- or high-risk elective surgical procedures at a single tertiary facility. During follow-up, 25 patients (9.1 percent) died and 29 patients (10.5 percent) experienced at least one complication after surgery, while 24 patients (8.7 percent) were discharged to nursing facilities.
A multidimensional frailty score composed of items including dependence in activities of daily living, dementia, and malnutrition appeared to help predict longer hospital stay, greater risk of death or need for discharge to a nursing facility in elderly patients after surgery.
"This model may support surgical treatments for fit older patients at low risk of complications, and it may also provide an impetus for better management of geriatric patients with a high risk of adverse outcomes after surgery."