Frailty Assessment Tools and Postoperative Outcomes among Elderly Patients Undergoing Elective Surgery: A prospective pilot study

Frailty is a complex geriatric syndrome that is relatively common among surgical patients worldwide. It is associated with several adverse postoperative outcomes, and additionally, it is a potentially treatable risk factor. The prevalence of surgical frailty in Iceland is not well known and there is a need to further predict its prevalence. The aim was to assess the prevalence of frailty according to three different clinically applicable screening tools in a cohort of elderly surgical patients undergoing elective surgery. In addition, we aimed to evaluate postoperative outcomes in relation to the screening results. Methods: Patients 65 years and older that underwent elective surgery were prospectively examined at the department of anesthesiology and critical care of Landspítali. The Clock Drawing Test (CDT), Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA-7) and Timed Up & Go (TUG) were used for preoperative assessment. Additional clinical data were extracted from the electronic medical records of Landspítali. The main postoperative outcomes measured were death, delirium, readmission and complications. Univariate analysis was utilized to compare frail versus non- frail groups according to assessment tools. Results: Of 99 patients who completed the assessment and underwent planned surgery, 42 (43%), 41 (41%), and 36 (37%) were at risk of frailty according to CDT, PRISMA-7 and TUG, respectively. An association between abnormal CDT and TUG and postoperative delirium was found. In addition, a combination of these two assessment tools was associated with surgical complications. For all screening tools, the incidence was higher for death, 90-day readmission, postoperative delirium and surgical complications in groups screening positive compared to groups screening negative. Conclusion: The risk of frailty is common (about 40%) among patients undergoing elective surgery in Iceland. The CDT, PRISMA-7 and TUG are feasible screening tools that have the potential to predict increased risk of adverse postoperative outcomes. Using a combination of these screening tools might subsequently be a convenient approach to recognizing patients that could benefit the most from prehabilitation.Yfirlýsin