Impact of frailty on surgical outcomes: The right patient for the right procedure.
Measuring frailty may improve patient selection for high-risk procedures.



Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent elective high-risk operative procedures, and a frailty index was used to classify the patients.



Our study analyzed 232,352 patients with a mean age of 65 years; the majority of patients were males (54%) and white (78%). The most common procedure was colectomy (41%), followed by lower extremity bypass (25%), gastrectomy (8%), endovascular abdominal aneurism repair (7%), pancreatectomy (7%), cardiac operation (6%), nephrectomy (3%), and pulmonary resection (2%). A majority of the patients were classified as mildly frail (34%), followed by nonfrail (29%), moderately frail (21%), and severely frail (15%). On univariate analysis, age, race, procedure, sex, and frailty scores were associated with complications, prolonged duration of stay, and 30-day mortality (P < .0001). On multivariate analysis, frailty was associated with complications, prolonged duration of stay, and 30-day mortality. Increasing frailty disproportionately impacted mortality; colectomy showed the greatest mortality in severely frail patients (9.36%), followed by esophagectomy (8.2%), pulmonary resection (6.4%), pancreatectomy (5.8%), cardiac procedures (4.4%), gastrectomy (4.3%), nephrectomy (3.32%), endovascular abdominal aneurism repair (2.49%), and lower extremity bypass (2.41%; P = .0001). A similar association between duration of stay and morbidity with frailty was noted.



Frailty has a significant impact on postoperative outcomes that varies with type of procedure.
Division of Surgical Oncology, East Carolina University Brody School of Medicine, Greenville, NC.
Catalina
C
Mosquera
Division of Bariatric and Minimally Invasive Surgery, East Carolina University Brody School of Medicine, Greenville, NC.
Konstantinos
K
Spaniolas
Division of Surgical Oncology, East Carolina University Brody School of Medicine, Greenville, NC. Electronic address: fitzgeraldt@ecu.edu.
Timothy L
TL
Fitzgerald
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D016330:Frail Elderly; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult