American College of Surgeons assesses frailty as a pre-op screening tool

April 30, 2019

The American College of Surgeons has released information on a study involving 14,530 surgical patients which was designed to assess frailty as an independent risk factor.  Using a common frailty index, researchers deemed 5.3 percent of inpatients and 2.5 percent of outpatients to have “high frailty”. Compared with low frailty patients, the presence of high frailty correlated with significantly worse outcomes within 30 days of the operation including:

  • Increased risk of experiencing a major complication (a composite of multiple serious complications): 2.9 and 1.8 times greater odds in the outpatient and inpatient groups, respectively
  • Longer median hospital stay, by 2.5 days; higher health care costs; and a 5.6 times greater chance of being discharged to a nursing facility for the inpatient group
  • Greater chance of being readmitted to the hospital: 4.8 times the odds for outpatients and 2.3 times the odds for inpatients
  • More than twice the odds of an emergency room visit after an outpatient procedure

Intermediate, or moderate, frailty significantly increased the risk of all these outcomes as well, the researchers reported. The study authors suggest that a frailty evaluation can be incorporated into the preoperative evaluation process as a risk stratification tool, and that if patients scheduled for a major or complex operation find out they have a high level of frailty, an option might be a “pre-habilitation” program, designed to optimize them prior to the procedure.