Frailty and One-year Mortality in Major Intra-abdominal Operations

• Published in: The Journal of surgical research 2016-06, Vol.203 (2), p.507-512.e1
• Main Authors: Li, Jessica L., BS, Henderson, Martha A., MD, Revenig, Louis M., MD, Sweeney, John F., MD, FACS, Kooby, David A., MD, FACS, Maithel, Shishir K., MD, FACS, Master, Viraj A., MD, PhD, FACS, Ogan, Kenneth, MD
• Format: Article
• Language: English
• Subjects: Abdomen - surgery; Adolescent; Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Frail Elderly; Frailty; Geriatric Assessment; Humans; Logistic Models; Male; Middle Aged; Mortality; Multivariate Analysis; Outcome Assessment (Health Care); Outcomes; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - mortality; Prospective Studies; Risk Assessment; Risk Factors; Surgery; Young Adult
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2016.03.007

Abstract Background Frailty is an objective measurement capable of preoperatively identifying patients with increased risk of 30-day morbidity and mortality, though less is known about its utility beyond that timeframe. We hypothesized that preoperative frailty is associated with an increased risk of one-year mortality in patients undergoing major intra-abdominal surgery. Materials and Methods Demographics, laboratory values, and traditional surgical risk assessments (American Society of Anesthesiologists scale, Eastern Cooperative Oncology Group Performance Status, Charlson Comorbidity Index) were collected prospectively. Preoperative frailty was evaluated using Fried criteria. Postoperative complications were defined by Clavien-Dindo Classification. One-year mortality data was gathered from phone calls, medical records, and the National Death Index. Results This study included 189 patients with a mean age of 62 years. 59.8% were male and 71.4% were Caucasian. At enrollment, 139 (73.5%) patients were considered “not frail”, while 50 (26.5%) were considered “intermediately frail” or “frail”. A total of 73 (38.6%) patients experienced a 30-day postoperative complication. At one year, 15 (7.9%) patients had died, 5 (3.6%) not frail and 10 (20.0%) intermediately frail/frail patients. Postoperative mortality occurred < 30 days, between 31-100 days, and > 100 days in 3, 4, and 8 patients respectively. Malignant neoplasm was documented as the underlying cause of death in 12 patients. All 30-day mortalities occurred in frail patients who had a postoperative complication. Conclusions Frailty status is predictive of one-year postoperative mortality. The Fried Frailty Criteria has the potential to more accurately evaluate surgical patients’ mortality risk beyond the immediate postoperative period, particularly when considered collectively with traditional surgical risk assessment tools.