Simplified Frailty Score Predicts Post-Operative Complications

MedicalResearch.com Interview with:
Louis M. Revenig, MD and
Kenneth Ogan MD, Department of Urology

Emory University School of Medicine
Atlanta, Georgia 30322

MedicalResearch: What is the background for this study? What are the main findings?

Response: Numerous groups from a variety of institutions have investigated different methods of quantifying frailty in surgical populations. All have shown that frailty not only can be measured, but more importantly, reliably identifies the patients who are at higher risk for poor postoperative outcomes compared to their peers.  One obstacle to more widespread use of frailty assessments is the extra burden it places on an already busy clinical setting. In our study we chose what we thought was the already simplest and most clinically applicable frailty assessment, the 5-component Fried Frailty Criteria, and prospectively enrolled a large cohort of surgical patients and followed their outcomes. We critically analyzed the data to assess which components of the frailty assessment were most important. Our results showed that of the 5 components (weight loss, grip strength, gait speed, exhaustion, and activity level), weight loss and grip strength alone carried the same prognostic information for post-operative outcomes as the full assessment. Additionally, when combined with two already routinely collected pre-operative variables (serum hemoglobin and ASA score) we created a novel, simple, and easy to use risk stratification system that is more amenable to a busy clinical setting.

MedicalResearch: What should clinicians and patients take away from your report?

Response: Patients who are at increased risk for post-operative complications compared to their peers of the same age can be reliably identified in the clinic using a frailty assessment such as the one we report in our study. While there are currently no studies demonstrating improved outcomes from any interventions, this can aid patient counseling of risks and highlight patients who deserve heightened attention in the post-operative period.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Response: First, our findings should be confirmed outside our own institution in patient populations that are geographically more diverse and outside an academic medical center, as well as groups undergoing more heterogeneous operations. Our group, among many others, have shown that frail patients can be readily identified pre-operatively. The next logical step of this research is to direct efforts towards a study that uses a pre-operative frailty assessment to identify patients predisposed to poor outcomes and, ideally in a randomized fashion, test interventions with the hypothesis that it will improve those patients’ post-operative outcomes.

Citation:

Louis M. Revenig, Daniel J. Canter, Sungjin Kim, Yuan Liu, John F. Sweeney, Juan M. Sarmiento, David A. Kooby, Shishir K. Maithel, Viraj A. Master, Kenneth Ogan. Report of a Simplified Frailty Score Predictive of Short-Term Postoperative Morbidity and Mortality. Journal of the American College of Surgeons, 2015;
DOI: 10.1016/j.jamcollsurg.2015.01.053

MedicalResearch.com Interview with: Louis M. Revenig, MD and, Kenneth Ogan MD, Department of Urology, Emory University School of Medicine, & Atlanta, Georgia 30322 (2015). Simplified Frailty Score Predicts Post-Operative Complications