title: Report of a Simplified Frailty Score Predictive of Short-Term Postoperative Morbidity and Mortality.
abstract: BACKGROUND
  Frailty is an objective method of quantifying a patient's fitness for surgery. Its clinical use is limited by the time needed to complete, as well as a lack of evidence-based interventions to improve outcomes in identified frail patients. The purpose of this study was to critically analyze the components of the Fried Frailty Criteria, among other preoperative variables, to create a simplified risk assessment amenable to a busy clinical setting, while maintaining prognostic ability for surgical outcomes.
  
  
  METHODS
  We performed a prospective evaluation of patients that included the 5-component Fried Frailty Criteria, traditional surgical risk assessments, biochemical laboratory values, and clinical and demographic data. Thirty-day postoperative outcomes were the outcomes of interest.
  
  
  RESULTS
  There were 351 consecutive patients undergoing major intra-abdominal operations enrolled. Analysis demonstrated that shrinking and grip strength alone hold the same prognostic information as the full 5-component Fried Frailty Criteria for 30-day morbidity and mortality. The addition of American Society of Anesthesia (ASA) score and serum hemoglobin creates a composite risk score, which facilitates easy classification of patients into discrete low (ref), intermediate (odds ratio [OR] 1.974, 95% CI 1.006 to 3.877, p = 0.048), and high (OR 4.889, 95% CI 2.220 to 10.769, p < 0.001) risk categories, with a corresponding stepwise increase in risk for 30-day postoperative complications. Internal validation by bootstrapping confirmed the results.
  
  
  CONCLUSIONS
  This study demonstrated that 2 components of the Fried Frailty Criteria, shrinking and grip strength, hold the same predictive value as the full frailty assessment. When combined with American Society of Anesthesiologists score and serum hemoglobin, they form a straightforward, simple risk classification system with robust prognostic information.
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Revenig
authors.affiliation: Department of Urology, Einstein Health Network and the Urologic Institute of Southeastern Pennsylvania, Philadelphia, PA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Canter
authors.affiliation: Winship Cancer Institute, Atlanta, GA.
authors.forename: Sungjin
authors.initials: S
authors.lastname: Kim
authors.affiliation: Winship Cancer Institute, Atlanta, GA.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
authors.affiliation: Department of General Surgery, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Atlanta, GA.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sarmiento
authors.affiliation: Department of Surgical Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Atlanta, GA.
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.affiliation: Department of Surgical Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Atlanta, GA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Laureen L
authors.initials: LL
authors.lastname: Hill
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Atlanta, GA.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Atlanta, GA. Electronic address: kogan@emory.edu.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ogan
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors