title: A prospective study examining the association between preoperative frailty and postoperative complications in patients undergoing minimally invasive surgery.
abstract: OBJECTIVE
  Current surgical decision-making is overly subjective and often misjudges a patient's physiologic state. The concept of frailty has gained recent recognition and potentially represents a measureable phenotype, which can quantify a patient's physiologic reserve and risk of an adverse surgical outcome. We sought to investigate the relationship between preoperative markers of frailty and postoperative complications in patients undergoing minimally invasive surgery (MIS).
  
  
  METHODS
  Frailty, using the methodology described by Fried and coworkers, was prospectively measured in patients who presented to urology, general surgery, and surgical oncology clinics where major MIS (endoscopic, laparoscopic, or robotic) was planned. The relationship between preoperative markers of frailty and 30-day postoperative complications was our primary outcome measure.
  
  
  RESULTS
  Our cohort includes 80 patients. Mean age and body mass index were 60.0 (range 19-87) years and 29.2 (range 18.4-53.1) kg/m(2), respectively. The majority of patients were male (57.5%) and Caucasian (65.0%). Thirteen patients were deemed "intermediately frail" or "frail," and the remaining 67 were classified as "not frail." Thirteen (16.25%) patients experienced any postoperative complication. Five (38.5%) of the intermediately frail and frail patients experienced a complication, compared with eight (11.9%) of the not frail patients (odds ratio=5.914; 95% confidence interval=1.25-27.96; P=0.025).
  
  
  CONCLUSIONS
  The advent of MIS has potentially lured surgeons into thinking older and patients with comorbidities may more easily tolerate this surgical approach compared with traditional open techniques. Our data suggest, however, that intermediately frail or frail patients are at increased risk of experiencing postoperative complications compared with not frail patients.
authors.affiliation: 1 Department of Urology, Emory University School of Medicine , Atlanta, Georgia .
authors.forename: Louis M
authors.initials: LM
authors.lastname: Revenig
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Canter
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: John G
authors.initials: JG
authors.lastname: Pattaras
authors.forename: Caroline
authors.initials: C
authors.lastname: Tai
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ogan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012371:Robotics; D012720:Severity of Illness Index; D055815:Young Adult