title: Frailty and one-year mortality in major intra-abdominal operations.
abstract: Frailty is an objective measurement capable of preoperatively identifying patients with increased risk of 30-d morbidity and mortality, though less is known about its utility beyond that timeframe. We hypothesized that preoperative frailty is associated with an increased risk of 1-y mortality in patients undergoing major intra-abdominal surgery.
  
  
  
  Demographics, laboratory values, and traditional surgical risk assessments (American Society of Anesthesiologists scale, Eastern Cooperative Oncology Group Performance Status, Charlson Comorbidity Index) were collected prospectively. Preoperative frailty was evaluated using Fried criteria. Postoperative complications were defined by Clavien-Dindo Classification. One-year mortality data were gathered from phone calls, medical records, and the National Death Index.
  
  
  
  This study included 189 patients with a mean age of 62 years. Of the total, 59.8% were male and 71.4% were Caucasian. At enrollment, 139 (73.5%) patients were considered "not frail", whereas 50 (26.5%) were considered "intermediately frail" or "frail". A total of 73 (38.6%) patients experienced a 30-d postoperative complication. At 1 y, 15 (7.9%) patients had died, 5 (3.6%) not frail and 10 (20.0%) intermediately frail/frail patients. Postoperative mortality occurred <30 d, between 31-100 d, and >100 d in 3, 4, and 8 patients, respectively. Malignant neoplasm was documented as the underlying cause of death in 12 patients. All 30-d mortalities occurred in frail patients who had a postoperative complication.
  
  
  
  Frailty status is predictive of 1-y postoperative mortality. The Fried Frailty Criteria has the potential to more accurately evaluate surgical patients' mortality risk beyond the immediate postoperative period, particularly when considered collectively with traditional surgical risk assessment tools.
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Li
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.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Revenig
authors.affiliation: Department of General Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
authors.affiliation: Department of Surgical Oncology, 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.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: kogan@emory.edu.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ogan
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: Frailty; Mortality; Outcomes