Frailty in Patients is Associated With Increased Risk For Adverse Events After Surgery

Frailty in older adults is associated with an increased risk of adverse events following noncardiac surgery, according to a cohort study.

Researchers at the Wake Forest University School of Medicine examined the association between frailty status—defined by a validated automated electronic frailty index (eFI) tool—and postoperative adverse events in patients recovering from noncardiac surgery. Electronic frailty index determines frailty status by using a combination of clinical encounters, diagnosis codes, laboratory workups, medications, and Medicare annual wellness visit data.

In their cohort study, researchers included patients aged 55 years or older who underwent at least 1 hour of noncardiac surgery (n = 33,449). The data spanned between October 1, 2017, and June 30, 2021.

Of the total, 11,563 (34.6%) were classified as fit, 15,928 (47.6%) as prefrail, and 5958 (17.8%) as frail. Patients with prefrail (odds ratio [OR] = 1.24; [95% CI, 1.18-1.30]; P < .001) and frail (OR = 1.71; [95% CI, 1.58-1.82]; P < .001) statuses were more likely to experience adverse events after surgery when compared with patients classified as fit. Further, the researchers found that “for every increase in eFI of 0.03 units, the odds of a composite of postoperative adverse events increased by 1.06 (95% CI, 1.03-1.13; P < .001).”

Based on their findings, the researchers concluded that increased monitoring and postoperative attention is needed for patients with frailty who pose an increased risk for adverse events post-surgery.

This study had limitations. For example, the authors noted that frailty is a dynamic state that can potentially change depending on when examined. But because of the study design, the authors could not make a conclusion based on the time-dependent nature of a patient’s eFI score.

Still, the authors believe there is a place for eFI tools moving forward.

“Deployment of eFI tools may help with easy screening and possible risk modification, especially in patients who will undergo high-risk surgery,” the researchers concluded.

Reference:

Khanna AK, Motamedi V, Bouldin B, et al. Automated electronic frailty index-identified frailty status and associated postsurgical adverse events. JAMA Netw Open. Published online November 6, 2023. doi:10.1001/jamanetworkopen.2023.41915