Frail Individuals Have Higher Risk of Poor Outcomes & Increased Length of Stay in Moderate to High Risk Elective Surgical Procedures

University of Arizona/Banner UniversityDepartment of Anesthesiology & Department of Geriatrics BACKGROUNDIn 2012 the American Geriatric Society alongside the American College of Surgeons released best practice guidelines for... [ view full abstract ]

University of Arizona/Banner University
Department of Anesthesiology & Department of Geriatrics 

BACKGROUND
In 2012 the American Geriatric Society alongside the American College of Surgeons released best practice guidelines for the preoperative assessment of geriatric surgical patients. Concurrently, the World Health Organization estimates there are currently 700 million people over the age of 65 with expectations of this number to increase dramatically over the coming years. These guidelines help direct appropriate care for the this population that is at significant risk of adverse postoperative outcomes. However, to our knowledge little evidence based data exist to delineate which geriatric patients pose the greatest risk.  

METHODS
Patients >60 years old undergoing elective moderate to high risk noncardiac surgery were sequentially recruited in our pre-anesthesia clinic. Multiple ACS/AGS assessments were performed, most notably the Fried Frailty Index. 90 day post-operative outcomes were tracked. 

RESULTS
116 patients (71 non frail, 29 pre-frail, 16 frail) were included in the final analysis. Frail and pre-frail were more likely to have high risk of post-operative complications including poor discharge disposition (18.8% of frail patient discharged home; 85.7% of non frail, p<.001) and increased length of stay (11.9 days in frail; 4.7 days in non frail, p<.001).

CONCLUSION
There was a clear association between the level of frailty and poor post operative outcomes. Those determined as frail (as indicated by the Fried Frailty Index) had a statistically significant increased risk of post-operative hospital and surgical complications including readmission, delirium and death. Geriatric patients have been known to be at risk for poor surgical outcomes but based on these results it appears that those determined as frail or pre-frail pose the highest risk. Opportunity exists for implication of "pre-hab" protocols to improve frailty scores thus reducing post operative complications.