Prevalence of frailty in elective surgery for older adults at Clínicas Hospital
Analysis of the surgical population of older adults at “Dr. Manuel Quintela” University Hospital from March, 2029 to March, 2020
DOI:
https://doi.org/10.29193/RMU.39.1.6Keywords:
FRAILTY, RISK ASSESSMENT, SURGERY, AGED, FRAILTY SCORES, PREVALENCEAbstract
Frailty determines an inability to cope with stressors due to decreased multisystem physiologic reserves. The surgical anesthetic act is a stressful event and the presence of frailty is an independent risk factor for perioperative morbidity and mortality Detection of frailty would allow for addressing reversible factors causing it, with the intention of reducing the risks that are inherent to anesthetic acts.
Detection in the perioperative assessment provides relevant information that is not obtained in a traditional evaluation. This approach has become the standard in perioperative assessment of geriatric surgical patients.
The study aims to assess the prevalence of frailty in elective surgery for the elderly at Clínicas Hospital.
Method: prospective, descriptive study approved by the institutional Ethics Committee. 206 patients aged 65 years old and over who had been coordinated for elective surgery were recruited for the study between March, 2019 and March, 2020. The Reported Edmonton Frailty Scale (REFS) was applied to detect frailty.
Prevalence of frailty was 22.8% with a CI of 16-29 in this population, rather high and similar to the frail patients percentages in other surgical and non-surgical settings. Significantly higher numbers of arterial hypertension, arrhythmias, diabetes and hypothyroidism cases and tobacco users were found among frail patients.
Prevalence and impact of frailty on operative morbidity and mortality are compelling reasons for its inclusion in the perioperative assessment of our health system, as well as the training of anesthesiologists in the detection of frailty through the use of practical, valid and reliable tools.
References
1) Savio I, Talice A, Vodanovich V. Guía de fragilidad en personas adultas mayores: criterios prácticos e instrumentos de pesquisa en el primer nivel de atención. Montevideo: MSP, 2022. Disponible en: https://www.gub.uy/ministerio-salud-publica/comunicacion/publicaciones/guia-fragilidad-personas-adultas-mayores. [Consul-ta:20/4/2022].
2) Savio. I. La atención de la fragilidad en el adulto mayor. Tendencias 2021; 58:127-36.
3) Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3):M146-56. doi: 10.1093/gerona/56.3.m146.
4) Etzioni D, Liu J, Maggard M, Ko C. The aging population and its im-pact on the surgery workforce. Ann Surg 2003; 238(2):170-7. doi: 10.1097/01.SLA.0000081085.98792.3d.
5) Speziale G, Nasso G, Barattoni M, Bonifazi R, Esposito G, Coppola R, et al. Operative and middle-term results of cardiac surgery in no-nagenarians: a bridge toward routine practice. Circulation 2010; 121(2):208-13. doi: 10.1161/CIRCULATIONAHA.108.807065.
6) Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62(7):722-7. doi: 10.1093/gerona/62.7.722.
7) Amblàs Novellas J, Martori J, Molist Brunet N, Oller R, Gómez Batiste X, Espaulella Panicot J. Índice frágil-VIG: diseño y evaluación de un índice de fragilidad basado en la valoración integral geriátrica. Rev Esp Geriatr Gerontol 2017; 52(3):119-27. doi: 10.1016/j.regg.2016.09.003.
8) Faller J, Pereira D, de Souza S, Nampo F, Orlandi F, Matumoto S. Instruments for the detection of frailty syndrome in older adults: a systematic review. PLoS One 2019; 14(4):e0216166. doi: 10.1371/journal.pone.0216166.
9) Dent E, Kowal P, Hoogendijk E. Frailty measurement in research and clinical practice: a review. Eur J Intern Med 2016; 31:3-10. doi: 10.1016/j.ejim.2016.03.007.
10) Milder D, Pillinger N, Kam P. The role of prehabilitation in frail surgical patients: A systematic review. Acta Anaesthesiol Scand 2018; 62(10):1356-66. doi: 10.1111/aas.13239.
11) Colburn J, Mohanty S, Burton J. Surgical guidelines for peri-operative management of older adults: what geriatricians need to know. J Am Geriatr Soc 2017; 65(6):1339-46. doi: 10.1111/jgs.14877.
12) McIsaac D, MacDonald D, Aucoin S. Frailty for perioperative clinicians: a narrative review. Anesth Analg 2020; 130(6):1450-60. doi: 10.1213/ANE.0000000000004602.
13) Collard R, Boter H, Schoevers R, Oude Voshaar R. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012; 60(8):1487-92. doi: 10.1111/j.1532-5415.2012.04054.x.
14) Banning L, El Moumni M, Visser L, van Leeuwen B, Zeebregts C, Pol R. Frailty leads to poor long-term survival in patients under-going elective vascular surgery. J Vasc Surg 2021; 73(6):2132-2139.e2. doi: 10.1016/j.jvs.2020.10.088.
15) Makary M, Segev D, Pronovost P, Syin D, Bandeen-Roche K, Patel P, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010; 210(6):901-8. doi: 10.1016/j.jamcollsurg.2010.01.028.
16) Wagner D, DeMarco M, Amini N, Buttner S, Segev D, Gani F, et al. Role of frailty and sarcopenia in predicting outcomes among pa-tients undergoing gastrointestinal surgery. World J Gastrointest Surg 2016; 8(1):27-40. doi: 10.4240/wjgs.v8.i1.27.
17) Rolfson D, Majumdar S, Tsuyuki R, Tahir A, Rockwood K. Va-lidity and reliability of the Edmonton Frail Scale. Age Ageing 2006; 35(5):526-9. doi: 10.1093/ageing/afl041.
18) Hilmer S, Perera V, Mitchell S, Murnion B, Dent J, Bajorek B, et al. The assessment of frailty in older people in acute care. Australas J Ageing 2009; 28(4):182-8. doi: 10.1111/j.1741-6612.2009.00367.x.
19) Bernabeu-Mora R, García-Guillamón G, Valera-Novella E, Giménez-Giménez L, Escolar-Reina P, Medina-Mirapeix F. Frailty is a predictive factor of readmission within 90 days of hospitalization for acute exacerbations of chronic obstructive pulmonary disease: a longitudinal study. Ther Adv Respir Dis 2017; 11(10):383-92. doi: 10.1177/1753465817726314.
20) Vargas J, Gálvez MA, Rojas M, Honorato M, Andrade M, Leyton P, et al . Fragilidad: en busca de herramientas de evaluación preoperatoria. Rev Méd Chile 2020; 148(3):311-9. doi: 10.4067/S0034-98872020000300311.
21) Maxwell C, Patel M, Suarez-Rodriguez L, Miller R. Frailty and prognostication in geriatric surgery and trauma. Clin Geriatr Med 2019; 35(1):13-26. doi: 10.1016/j.cger.2018.08.002.
22) Bautista L, DiDonato R, Bennett K, Bautista M. The Edmonton Frail Scale as a preoperative assessment tool in elective outpatient surgery. Can J Anaesth 2021; 68(6):925-7. doi: 10.1007/s12630-021-01954-y.
23) Dhesi J, Lees N, Partridge J. Frailty in the perioperative setting. Clin Med (Lond) 2019; 19(6):485-9. doi: 10.7861/clinmed.2019-0283.
24) O’Caoimh R, Sezgin D, O’Donovan M, Molloy D, Clegg A, Rockwood K, et al. Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing 2021; 50(1):96-104. doi: 10.1093/ageing/afaa219.
25) Ramírez Ramírez J, Cadena Sanabria M, Ochoa M. Aplicación de la Escala de fragilidad de Edmonton en población colombiana. Comparación con los criterios de Fried. Rev Esp Geriatr Gerontol 2017; 52(6):322-5. doi: 10.1016/j.regg.2017.04.001.
26) Cooper Z, Rogers SJr, Ngo L, Guess J, Schmitt E, Jones R, et al. Comparison of frailty measures as predictors of outcomes after orthopedic surgery. J Am Geriatr Soc 2016; 64(12):2464-71. doi: 10.1111/jgs.14387.
27) Robinson T, Wu D, Pointer L, Dunn C, Cleveland JJr, Moss M. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 2013; 206(4):544-50. doi: 10.1016/j.amjsurg.2013.03.012.
28) Lin H, Watts J, Peel N, Hubbard R. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Ger-iatr 2016; 16(1):157. doi: 10.1186/s12877-016-0329-8.
29) Bissot M, Henin P, Aunac S, Colinet B, Barvais L, Simonet O, et al. Preoperative frailty assessment: a review. Acta Anaesthesiol Belg 2016; 67(4):157-73.
30) Chow W, Rosenthal R, Merkow R, Ko C, Esnaola N. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 2012; 215(4):453-66. doi: 10.1016/j.jamcollsurg.2012.06.017.
31) Murthy S, Hepner D, Cooper Z, Bader A, Neuman M. Contro-versies in anaesthesia for noncardiac surgery in older adults. Br J Anaesth 2015; 115(Suppl 2):ii15-25. doi: 10.1093/bja/aev396.
32) Aucoin S, Hao M, Sohi R, Shaw J, Bentov I, Walker D, et al. Accuracy and feasibility of clinically applied frailty instruments be-fore surgery: a systematic review and meta-analysis. Anesthesio-logy 2020; 133(1):78-95. doi: 10.1097/ALN.0000000000003257.
33) Fernandes J, Gomes C, Guerra R, Pirkle C, Vafaei A, Curcio C, et al. Frailty syndrome and risk of cardiovascular disease: analysis from the International Mobility in Aging Study. Arch Gerontol Geriatr 2021; 92:104279. doi: 10.1016/j.archger.2020.104279.
34) Newman A, Gottdiener J, Mcburnie M, Hirsch C, Kop W, Tracy R, et al. Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci Med Sci 2001; 56(3):M158-66. doi: 10.1093/gerona/56.3.m158.
35) Stewart R. Cardiovascular disease and frailty: what are the mechanistic links? Clin Chem 2019; 65(1):80-6. doi: 10.1373/clinchem.2018.287318.
2) Savio. I. La atención de la fragilidad en el adulto mayor. Tendencias 2021; 58:127-36.
3) Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3):M146-56. doi: 10.1093/gerona/56.3.m146.
4) Etzioni D, Liu J, Maggard M, Ko C. The aging population and its im-pact on the surgery workforce. Ann Surg 2003; 238(2):170-7. doi: 10.1097/01.SLA.0000081085.98792.3d.
5) Speziale G, Nasso G, Barattoni M, Bonifazi R, Esposito G, Coppola R, et al. Operative and middle-term results of cardiac surgery in no-nagenarians: a bridge toward routine practice. Circulation 2010; 121(2):208-13. doi: 10.1161/CIRCULATIONAHA.108.807065.
6) Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 2007; 62(7):722-7. doi: 10.1093/gerona/62.7.722.
7) Amblàs Novellas J, Martori J, Molist Brunet N, Oller R, Gómez Batiste X, Espaulella Panicot J. Índice frágil-VIG: diseño y evaluación de un índice de fragilidad basado en la valoración integral geriátrica. Rev Esp Geriatr Gerontol 2017; 52(3):119-27. doi: 10.1016/j.regg.2016.09.003.
8) Faller J, Pereira D, de Souza S, Nampo F, Orlandi F, Matumoto S. Instruments for the detection of frailty syndrome in older adults: a systematic review. PLoS One 2019; 14(4):e0216166. doi: 10.1371/journal.pone.0216166.
9) Dent E, Kowal P, Hoogendijk E. Frailty measurement in research and clinical practice: a review. Eur J Intern Med 2016; 31:3-10. doi: 10.1016/j.ejim.2016.03.007.
10) Milder D, Pillinger N, Kam P. The role of prehabilitation in frail surgical patients: A systematic review. Acta Anaesthesiol Scand 2018; 62(10):1356-66. doi: 10.1111/aas.13239.
11) Colburn J, Mohanty S, Burton J. Surgical guidelines for peri-operative management of older adults: what geriatricians need to know. J Am Geriatr Soc 2017; 65(6):1339-46. doi: 10.1111/jgs.14877.
12) McIsaac D, MacDonald D, Aucoin S. Frailty for perioperative clinicians: a narrative review. Anesth Analg 2020; 130(6):1450-60. doi: 10.1213/ANE.0000000000004602.
13) Collard R, Boter H, Schoevers R, Oude Voshaar R. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012; 60(8):1487-92. doi: 10.1111/j.1532-5415.2012.04054.x.
14) Banning L, El Moumni M, Visser L, van Leeuwen B, Zeebregts C, Pol R. Frailty leads to poor long-term survival in patients under-going elective vascular surgery. J Vasc Surg 2021; 73(6):2132-2139.e2. doi: 10.1016/j.jvs.2020.10.088.
15) Makary M, Segev D, Pronovost P, Syin D, Bandeen-Roche K, Patel P, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010; 210(6):901-8. doi: 10.1016/j.jamcollsurg.2010.01.028.
16) Wagner D, DeMarco M, Amini N, Buttner S, Segev D, Gani F, et al. Role of frailty and sarcopenia in predicting outcomes among pa-tients undergoing gastrointestinal surgery. World J Gastrointest Surg 2016; 8(1):27-40. doi: 10.4240/wjgs.v8.i1.27.
17) Rolfson D, Majumdar S, Tsuyuki R, Tahir A, Rockwood K. Va-lidity and reliability of the Edmonton Frail Scale. Age Ageing 2006; 35(5):526-9. doi: 10.1093/ageing/afl041.
18) Hilmer S, Perera V, Mitchell S, Murnion B, Dent J, Bajorek B, et al. The assessment of frailty in older people in acute care. Australas J Ageing 2009; 28(4):182-8. doi: 10.1111/j.1741-6612.2009.00367.x.
19) Bernabeu-Mora R, García-Guillamón G, Valera-Novella E, Giménez-Giménez L, Escolar-Reina P, Medina-Mirapeix F. Frailty is a predictive factor of readmission within 90 days of hospitalization for acute exacerbations of chronic obstructive pulmonary disease: a longitudinal study. Ther Adv Respir Dis 2017; 11(10):383-92. doi: 10.1177/1753465817726314.
20) Vargas J, Gálvez MA, Rojas M, Honorato M, Andrade M, Leyton P, et al . Fragilidad: en busca de herramientas de evaluación preoperatoria. Rev Méd Chile 2020; 148(3):311-9. doi: 10.4067/S0034-98872020000300311.
21) Maxwell C, Patel M, Suarez-Rodriguez L, Miller R. Frailty and prognostication in geriatric surgery and trauma. Clin Geriatr Med 2019; 35(1):13-26. doi: 10.1016/j.cger.2018.08.002.
22) Bautista L, DiDonato R, Bennett K, Bautista M. The Edmonton Frail Scale as a preoperative assessment tool in elective outpatient surgery. Can J Anaesth 2021; 68(6):925-7. doi: 10.1007/s12630-021-01954-y.
23) Dhesi J, Lees N, Partridge J. Frailty in the perioperative setting. Clin Med (Lond) 2019; 19(6):485-9. doi: 10.7861/clinmed.2019-0283.
24) O’Caoimh R, Sezgin D, O’Donovan M, Molloy D, Clegg A, Rockwood K, et al. Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing 2021; 50(1):96-104. doi: 10.1093/ageing/afaa219.
25) Ramírez Ramírez J, Cadena Sanabria M, Ochoa M. Aplicación de la Escala de fragilidad de Edmonton en población colombiana. Comparación con los criterios de Fried. Rev Esp Geriatr Gerontol 2017; 52(6):322-5. doi: 10.1016/j.regg.2017.04.001.
26) Cooper Z, Rogers SJr, Ngo L, Guess J, Schmitt E, Jones R, et al. Comparison of frailty measures as predictors of outcomes after orthopedic surgery. J Am Geriatr Soc 2016; 64(12):2464-71. doi: 10.1111/jgs.14387.
27) Robinson T, Wu D, Pointer L, Dunn C, Cleveland JJr, Moss M. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 2013; 206(4):544-50. doi: 10.1016/j.amjsurg.2013.03.012.
28) Lin H, Watts J, Peel N, Hubbard R. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Ger-iatr 2016; 16(1):157. doi: 10.1186/s12877-016-0329-8.
29) Bissot M, Henin P, Aunac S, Colinet B, Barvais L, Simonet O, et al. Preoperative frailty assessment: a review. Acta Anaesthesiol Belg 2016; 67(4):157-73.
30) Chow W, Rosenthal R, Merkow R, Ko C, Esnaola N. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 2012; 215(4):453-66. doi: 10.1016/j.jamcollsurg.2012.06.017.
31) Murthy S, Hepner D, Cooper Z, Bader A, Neuman M. Contro-versies in anaesthesia for noncardiac surgery in older adults. Br J Anaesth 2015; 115(Suppl 2):ii15-25. doi: 10.1093/bja/aev396.
32) Aucoin S, Hao M, Sohi R, Shaw J, Bentov I, Walker D, et al. Accuracy and feasibility of clinically applied frailty instruments be-fore surgery: a systematic review and meta-analysis. Anesthesio-logy 2020; 133(1):78-95. doi: 10.1097/ALN.0000000000003257.
33) Fernandes J, Gomes C, Guerra R, Pirkle C, Vafaei A, Curcio C, et al. Frailty syndrome and risk of cardiovascular disease: analysis from the International Mobility in Aging Study. Arch Gerontol Geriatr 2021; 92:104279. doi: 10.1016/j.archger.2020.104279.
34) Newman A, Gottdiener J, Mcburnie M, Hirsch C, Kop W, Tracy R, et al. Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci Med Sci 2001; 56(3):M158-66. doi: 10.1093/gerona/56.3.m158.
35) Stewart R. Cardiovascular disease and frailty: what are the mechanistic links? Clin Chem 2019; 65(1):80-6. doi: 10.1373/clinchem.2018.287318.
Downloads
Published
2023-03-16
How to Cite
1.
García R, Noya B, Surbano M, Cavallieri F, Bouchacourt JP, Illescas L, et al. Prevalence of frailty in elective surgery for older adults at Clínicas Hospital: Analysis of the surgical population of older adults at “Dr. Manuel Quintela” University Hospital from March, 2029 to March, 2020. Rev. Méd. Urug. [Internet]. 2023 Mar. 16 [cited 2024 Nov. 24];39(1):e205. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/1015
Issue
Section
Original Articles
