Newly Published
Perioperative Medicine  |   September 2019
Deficit Accumulation and Phenotype Assessments of Frailty Both Poorly Predict Duration of Hospitalization and Serious Complications after Noncardiac Surgery
Author Notes
  • From the Departments of General Anesthesiology (A.K., L.A.S., L.B., A.R., K.C.C.), and Outcomes Research (A.K., N.M., D.Y., D.I.S.), Anesthesiology Institute (A.S.), the Nursing Institute (L.A.S., L.B., A.R.), and the Department of Quantitative Health Sciences (N.M., D.Y.), Cleveland Clinic, Cleveland, Ohio. Current positions: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts (A.S.).
  • Part of the work presented in this article has been presented as an abstract at the annual meeting of the American Society of Anesthesiologists, Boston, Massachusetts, on October 22, 2017.
    Part of the work presented in this article has been presented as an abstract at the annual meeting of the American Society of Anesthesiologists, Boston, Massachusetts, on October 22, 2017.×
  • Submitted for publication May 12, 2018. Accepted for publication July 16, 2019.
    Submitted for publication May 12, 2018. Accepted for publication July 16, 2019.×
  • Correspondence: Address correspondence to Dr. Sonny: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114. asonny@mgh.harvard.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Ethics / Medicolegal Issues / Patient Safety / Quality Improvement
Perioperative Medicine   |   September 2019
Deficit Accumulation and Phenotype Assessments of Frailty Both Poorly Predict Duration of Hospitalization and Serious Complications after Noncardiac Surgery
Anesthesiology Newly Published on September 12, 2019. doi:10.1097/ALN.0000000000002959
Anesthesiology Newly Published on September 12, 2019. doi:10.1097/ALN.0000000000002959
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Frailty is not uncommon in the surgical population, with reported incidences of 2 to 45%, depending on the assessment used and the population assessed

  • Frailty has been associated with adverse outcomes after a variety of surgical procedures, elective or emergent, and in different age groups

  • Frailty can be assessed with various approaches and measurement tools

What This Article Tells Us That Is New:

  • The Hopkins Frailty Score (a phenotype model) and the Modified Frailty Index score (a measure of deficit accumulation) were both poor predictors of unexpected prolonged hospital stay and a composite of readmission and serious complications

Background: Frailty is associated with adverse postoperative outcomes, but it remains unclear which measure of frailty is best. This study compared two approaches: the Modified Frailty Index, which is a deficit accumulation model (number of accumulated deficits), and the Hopkins Frailty Score, which is a phenotype model (consisting of shrinking, weakness, exhaustion, slowness, and low physical activity). The primary aim was to compare the ability of each frailty score to predict prolonged hospitalization. Secondarily, the ability of each score to predict 30-day readmission and/or postoperative complications was compared.

Methods: This study prospectively enrolled adults presenting for preanesthesia evaluation before elective noncardiac surgery. The Hopkins Frailty Score and Modified Frailty Index were both determined. The ability of each frailty score to predict the primary outcome (prolonged hospitalization) was compared using a ratio of root-mean-square prediction errors from linear regression models. The ability of each score to predict the secondary outcome (readmission and complications) was compared using ratio of root-mean-square prediction errors from logistic regression models.

Results: The study included 1,042 patients. The frailty rates were 23% (Modified Frailty Index of 4 or higher) and 18% (Hopkins Frailty Score of 3 or higher). In total, 12.9% patients were readmitted or had postoperative complications. The error of the Modified Frailty Index and Hopkins Frailty Score in predicting the primary outcome was 2.5 (95% CI, 2.2, 2.9) and 2.6 (95% CI, 2.2, 3.0) days, respectively, and their ratio was 1.0 (95% CI, 1.0, 1.0), indicating similarly poor prediction. Similarly, the error of respective frailty scores in predicting the probability of secondary outcome was high, specifically 0.3 (95% CI, 0.3, 0.4) and 0.3 (95% CI, 0.3, 0.4), and their ratio was 1.00 (95% CI, 1.0, 1.0).

Conclusions: The Modified Frailty Index and Hopkins Frailty Score were similarly poor predictors of perioperative risk. Further studies, with different frailty screening tools, are needed to identify the best method to measure perioperative frailty.