Frail Oldsters Do Less Well in the Hands of the Surgeons

Surgeons know that some patients over 65 do less well after surgery, and are more likely to have complications, longer hospital stays, or end up in nursing homes.  But how can these subjects be recognized in advance?  Predictive formulae base on cardiac health or medical history have proved to be relatively worthless.  This has led Johns Hopkins physicians to investigate ‘frailty’ as a possible predictor.  They report their findings in the Journal of the American College of Surgeons.

A scale for frailty was established and validated.  It had 5 items: weakness, weight loss, exhaustion, low physical activity, and slow walking speed; each was scored negative or positive.  A total of 4 or 5 was classified as frail, 2 or 3 as intermediate frail, and 0 or 1 as non-frail.  This scale was applied to 594 patients over 65 presenting for elective surgery.  The outcomes measured were 30-day surgical complications, length of hospital stay, and disposition on discharge.   

The results showed that patients who were pre-operatively frail were 2½ times as likely as those who were not to have a complication from surgery, 1½ times as likely to stay longer in hospital, and 20 times as likely to be discharged to a nursing home or assisted living facility instead of their home.  Intermediate frail patients’ post-operative outcomes were intermediate.

As a minimum, use of the frailty score as a pre-operative assessment should alert physicians to special needs and risks of older patients.  Closer monitoring, attention to hydration, nutrition, and mobilization may improve the frail subjects’ outcomes.  And, given sufficient time before the elective surgery, may allow frail patients to undertake a remedial program – high intensity resistance exercise training, for instance – to improve their condition before surgery . . .