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Frailty Assessment Tools and Associated Postoperative Outcomes in Older Patients Undergoing Elective Surgery: A Prospective Pilot Study.

BACKGROUND
There is a need for a feasible tool to assess the risk of frailty prior to surgery. We aimed to identify the ratio of abnormal results for three clinically applicable screening tools to assess the risk of frailty, and their association with adverse outcomes in a cohort of elderly surgical patients.


METHODS
In this prospective pilot study, patients ≥ 65 years undergoing preoperative evaluation for elective surgery were included and subjected to three frailty screening tests; Program of Research to Integrate Services for the Maintenance of Autonomy 7-item questionnaire (PRISMA7), Timed Up & Go (TUG) and Clock Drawing Test (CDT). The primary outcome was the incidence of abnormal testing, and secondary outcomes were association between abnormal tests and mortality, readmission, delirium, surgical complications and non-home discharge.


RESULTS
Out of 99 patients, 41%, 37% and 43% had an abnormal PRISMA7, TUG and CDT screening, respectively. Postoperative delirium was more likely to occur in patients with abnormal TUG screening (19% vs. 3%, p=0.011) and CDT (17% vs. 2%, p=0.019). When analyzing screening tool combinations, patients with abnormal PRISMA7 and TUG had a higher rate of non-home discharge (38% vs. 17%, p=0.029); and patients with abnormal TUG and CDT had a higher rate of postoperative delirium (25% vs. 3%, p=0.006) and any surgical complication (58% vs. 38%, p=0.037); and patients with abnormal results from all three tools had a higher rate of postoperative delirium (21% vs. 5%, p=0.045) and non-home discharge (42% vs. 18%, p=0.034).


CONCLUSION
Approximately 40% of elderly surgical patients have abnormal PRISMA7, TUG and CDT screening tests for frailty, and they are associated individually or in combination with increased risk of adverse postoperative outcomes. The results will aid in designing studies to risk-stratify patients at risk of frailty further and attempt to modify associated outcomes. This article is protected by copyright. All rights reserved.