title: Preoperative quantification of perceptions of surgical frailty.
abstract: BACKGROUND
  Frailty has gained recognition as an objective measure of a patient's physiologic reserve that ideally can replace the subjective biases of surgeons. In this study, we sought to examine the concordance between patient and attending surgeon perceptions of the patient's "fitness" before surgery. We then correlated these ratings with the patient's objective frailty scores.
  
  
  METHODS
  Patients were prospectively enrolled from urology, general surgery, and surgical oncology clinics. Patients were asked to rate their ability to withstand the physical stress of the scheduled surgery on a visual analog scale. The operating surgeon then independently rated his assessment of the patient's ability to withstand surgery blinded to the patient's self assessment.
  
  
  RESULTS
  A total of 203 patients were included. Median patient age and body mass index were 62 (range = 21-87) years and 28.1 kg/m(2) (18.0-53.1), respectively. The majority of patients were white (67%) and male (60.6%). A patients' self-assessment showed no correlation with their age; however, surgeons' ratings showed a positive correlation with patients' age. Patients' self-rated scores showed a positive correlation with their frailty score, although surgeons' ratings showed a stronger correlation. However, when stratified by age group, the positive correlation and predictive ability were lost (P value = 0.198).
  
  
  CONCLUSIONS
  Although age is an established risk factor, our data demonstrate surgeons may place an overreliance on a patient's age in place of an objective measure of physiologic reserve. Conversely, patients tended to overestimate their ability to withstand the stress of surgery, possibly leading to unrealistic expectations of their recovery and outcomes.
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Revenig
authors.affiliation: The Fox Chase Cancer Center, Einstein Health Network and The Urologic Institute of Southeastern Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Canter
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Henderson
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia; Department of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ogan
authors.affiliation: Department of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.affiliation: Department of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Sungjin
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia. Electronic address: vmaster@emory.edu.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D059026:Diagnostic Self Evaluation; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D018570:Risk Assessment; D055815:Young Adult
keywords: Frailty; Outcomes; Patient attitudes; Patient expectations; Surgery