Newly Published
Correspondence  |   June 2020
Preoperative Frailty Assessment: Comment
Author Notes
  • Mayo Clinic, Rochester, Minnesota (R.L.J.). johnson.rebecca1@mayo.edu
  • (Accepted for publication May 6, 2020.)
    (Accepted for publication May 6, 2020.)×
Article Information
Correspondence
Correspondence   |   June 2020
Preoperative Frailty Assessment: Comment
Anesthesiology Newly Published on June 11, 2020. doi:https://doi.org/10.1097/ALN.0000000000003401
Anesthesiology Newly Published on June 11, 2020. doi:https://doi.org/10.1097/ALN.0000000000003401
We read with interest the article by Sonny et al.1  comparing two methods for frailty measurement in the ability to predict hospital length of stay after noncardiac surgery. Assessments of frailty have been relevant in surgical outcomes research since milestone work by Makary et al.2  With more than 60 instruments to measure frailty currently avzailable and no consensus on how to integrate frailty measures into perioperative management, we agree with the authors that assessing comparative predictive accuracy between different frailty instruments is timely and clinically relevant.
It is not surprising, however, that the two measures selected (the phenotypic Hopkins Frailty Score and a modified deficit accumulation score [i.e., frailty index]) in the study of Sonny et al.1  demonstrated large error in the prediction of prolonged hospitalization across a heterogeneous group of patients undergoing noncardiac surgery. Many studies evaluating perioperative prediction models have consistently shown substantial challenges in accurately estimating prolonged hospitalization. Indeed, of routinely collected outcomes, hospital length of stay has arguably the highest variation and most substantial contribution from indirect patient predictors (e.g., social status, home supports, availability of allied health services). Neither of the frailty instruments tested by Sonny et al.1  capture these factors and are therefore unlikely to accurately predict or explain a substantial degree of variance in prolongation of stay.