Frailty as a Predictor of Surgical Outcomes in Older Patients

Abstract

Older patients are at increased risk for postoperative complications.¹ x 1 Polanczyk, C.A., Marcantonio, E., Goldman, L. et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med. 2001; 134: 637–643 Crossref | PubMed | Scopus (256) | Google Scholar See all References If a complication occurs, it can lead to a cascade of events resulting in disability, loss of independence, diminished quality of life, high health care costs, and mortality.² x 2 Hamel, M.B., Henderson, W.G., Khuri, S.F., and Daley, J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005; 53: 424–429 Crossref | PubMed | Scopus (292) | Google Scholar See all References As the aging population expands, older patients are increasingly presenting for surgical evaluation.³ x 3 Etzioni, D.A., Liu, J.H., O'Connell, J.B. et al. Elderly patients in surgical workloads: a population-based analysis. Am Surg. 2003; 69: 961–965 PubMed | Google Scholar See all References Surgical decision making in this population is challenging because of the heterogeneity of health status in older adults and the paucity of tools for predicting operative risk. Commonly used predictors of postoperative complications have substantial limitations; most are based on a single organ system or are subjective, and none estimate a patient's physiologic reserves.⁴ x 4 Davenport, D.L., Bowe, E.A., Henderson, W.G. et al. National surgical quality improvement program (NSQIP) risk factors can be used to validate American Society of Anesthesiologists physical status classification (ASA PS) levels. Ann Surg. 2006; 243: 636–641 (discussion 641–644) Crossref | PubMed | Scopus (155) | Google Scholar See all References For example, the Lee and Eagle criteria account for cardiac function only,⁵ x 5 Eagle, K.A., Berger, P.B., Calkins, H. et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to update the 1996 guidelines on perioperative cardiovascular evaluation for noncardiac surgery). J Am Coll Cardiol. 2002; 39: 542–553 Abstract | Full Text | Full Text PDF | PubMed | Scopus (516) | Google Scholar See all References ^{, 6} x 6 Lee, T.H., Marcantonio, E.R., Mangione, C.M. et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100: 1043–1049 Crossref | PubMed | Scopus (1967) | Google Scholar See all References and the popular American Society of Anesthesiology (ASA) score is determined by a subjective estimate of organ system disease and likelihood of survival.⁷ x 7 Saklad, M. Grading of patients for surgical procedures. Anesthesiology. 1941; 2: 281–284 Crossref | Google Scholar See all References Despite the widespread adoption of these scoring systems, complications in older patients remain difficult to accurately predict.