title: Do first impressions count? Frailty judged by initial clinical impression predicts medium-term mortality in vascular surgical patients.
abstract: Recognising frailty during pre-operative assessment is important. Frail patients experience higher mortality rates and are less likely to return to baseline functional status following the physiological insult of surgery. We evaluated the association between an initial clinical impression of frailty and all-cause mortality in 392 patients attending our vascular pre-operative assessment clinic. Prevalence of frailty assessed by the initial clinical impression was 30.6% (95% CI 26.0-35.2%). There were 133 deaths in 392 patients over a median follow-up period of 4 years. Using Cox regression, adjusted for age, sex, revised cardiac risk index and surgery (yes/no), the hazard ratio for mortality for frail vs. not-frail was 2.14 (95% CI 1.51-3.05). The time to 20% mortality was 16 months in the frail group and 33 months in the not-frail group. The initial clinical impression is a useful screening tool to identify frail patients in pre-operative assessment.
authors.affiliation: Department of Anaesthesia, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK.
authors.forename: B R
authors.initials: BR
authors.lastname: O'Neill
authors.affiliation: Health and Social Care Institute, Teesside University, Middlesbrough, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Batterham
authors.affiliation: Department of General & Vascular Surgery, James Cook University Hospital, Middlesbrough, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Hollingsworth
authors.affiliation: Northern School of Anaesthesia and Intensive Care Medicine, Health Education North East, Newcastle-upon-Tyne, UK.
authors.forename: J W
authors.initials: JW
authors.lastname: Durrand
authors.affiliation: Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK.|Health and Social Care Institute, Teesside University, Middlesbrough, UK.
authors.forename: G R
authors.initials: GR
authors.lastname: Danjoux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D000073496:Frailty; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D016016:Proportional Hazards Models; D014656:Vascular Surgical Procedures / Q000401:mortality*
keywords: frailty; initial clinical impression; mortality; pre-operative; vascular