Study: Frailty May Be Underrecognized in Patients Referred for Major Surgery

Frailty or pre-frailty is common among patients deemed candidates for thoracic surgical procedures, according to a new study.

“Most studies of frailty in populations of patients identify a frequency of 30% to 40%,” said study author Mark K. Ferguson, MD, professor of surgery at the University of Chicago Medicine. “In our study, nearly 70% of patients were frail or pre-frail. This is a very high percentage and indicates that it may be appropriate to develop formal interventions for frailty in patients who are at increased surgical risk.”

Frailty is associated with poorer outcomes after major surgery, such as increased duration of hospitalization, decreased ability to recover from complications, and a higher frequency of hospital discharge to a nursing home or rehabilitation facility, he said.
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The researchers performed a prospective cohort study at a single-site thoracic surgical clinic. Starting October 1, 2014, surgical candidates aged 60 years or older who consented to be screened were included. Patients were screened using an adapted version of Fried’s phenotypic frailty criteria: weakness (grip strength), slow gait (15-foot walk), unintentional weight loss, self-reported exhaustion, and low self-reported physical activity (Physical Activity Scale for the Elderly). The investigators identified pre-frailty when participants demonstrated 1 or 2 frailty characteristics and frailty when they demonstrated 3 to 5 frailty characteristics.

Of 180 eligible patients, 126 consented and 125 completed screening. The researchers found that 39 participants (31%) were not frail, while they classified 71 (57%) as pre-frail and 15 (12%) as frail. Exhaustion was the most common frailty symptom (34%). Frailty prevalence did not significantly differ among men and women (men, 10%; women, 14%; P=.75).

“Frailty is not a strict contraindication to surgery, but it does demand that physicians, patients, and their families take this into account when discussing surgical treatment, surgical alternatives, and outcomes after major surgery,” Dr Ferguson said.

His research team members are incorporating routine frailty screening for their potential surgical patients, and they have started a trial of exercise intervention for frail and pre-frail patients to determine whether this reduces surgical risk and improves outcomes. In addition, they are investigating other methods of assessing their patients, such as blood markers and measurements of muscle size and density on computed tomography scans.

—Mike Bederka

Reference:

Beckert AK, Huisingh-Scheetz M, Thompson K, et al. Screening for frailty in thoracic surgical patients [published online October 6, 2016]. Ann Thorac Surg. doi:10.1016/j.athoracsur.2016.08.078.