Effects of the Frailty Phenotype on Post-operative Complications in Older Surgical Patients: a Systematic Review and Meta-analysis

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2019 May 26

PMID 31126245

Citations 19

Authors

Binru Han

Qiuping Li

Xi Chen

Affiliations

Soon will be listed here.

Abstract

Background: Frailty has been generally been associated with adverse events in older patients under surgery. Frailty phenotype is the most widely used instrument in the research literature. However the effect of the frailty phenotype on post-operative events was still unclear. The purpose of this systematic review was to explore the association between frailty phenotype and post-operative complications among surgical patients aged 60 years and over.

Methods: Relevant studies were identified by systematically searching of PubMed, Embase, the Cochrane Library and the Web of Science databases from their beginning to March 2017. Both random-effects models and fixed-effects models were used to combine the risk ratios (RRs) and 95% confidence intervals (CIs). A subgroup analysis was performed to identify the sources of heterogeneity and a sensitivity analysis to identify the strength of the results.

Results: Twelve prospective cohort studies involving a total of 2278 patients were included. The risk of post-operative complications in the frail group was higher than the non-frail group (RR: 1.6; 95% CI: 1.60-2.13). Compared with the robust group, geriatric patients with frailty or pre-frailty had a higher risk of post-operative complications. The RRs were 1.77 (95% CI: 1.40-2.25) and 1.45 (95% CI: 1.17-1.80), respectively.

Conclusion: Frailty phenotype should be considered as a useful risk assessment tool for preoperative evaluations of geriatric patients by medical staff.

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References

Clegg A, Young J, Iliffe S, Rikkert M, Rockwood K . Frailty in elderly people. Lancet. 2013; 381(9868):752-62. PMC: 4098658. DOI: 10.1016/S0140-6736(12)62167-9. View

Dominguez-Rodriguez A, Abreu-Gonzalez P, Jimenez-Sosa A, Gonzalez J, Caballero-Estevez N, Martin-Casanas F . The impact of frailty in older patients with non-ischaemic cardiomyopathy after implantation of cardiac resynchronization therapy defibrillator. Europace. 2015; 17(4):598-602. DOI: 10.1093/europace/euu333. View

Abdullahi Y, Athanasopoulos L, Casula R, Moscarelli M, Bagnall M, Ashrafian H . Systematic review on the predictive ability of frailty assessment measures in cardiac surgery. Interact Cardiovasc Thorac Surg. 2017; 24(4):619-624. DOI: 10.1093/icvts/ivw374. View

Stang A . Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25(9):603-5. DOI: 10.1007/s10654-010-9491-z. View

Oakland K, Nadler R, Cresswell L, Jackson D, Coughlin P . Systematic review and meta-analysis of the association between frailty and outcome in surgical patients. Ann R Coll Surg Engl. 2016; 98(2):80-5. PMC: 5210486. DOI: 10.1308/rcsann.2016.0048. View

Buigues C, Juarros-Folgado P, Fernandez-Garrido J, Navarro-Martinez R, Cauli O . Frailty syndrome and pre-operative risk evaluation: A systematic review. Arch Gerontol Geriatr. 2015; 61(3):309-21. DOI: 10.1016/j.archger.2015.08.002. View

Buta B, Walston J, Godino J, Park M, Kalyani R, Xue Q . Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev. 2015; 26:53-61. PMC: 4806795. DOI: 10.1016/j.arr.2015.12.003. View

Kistler E, Nicholas J, Kates S, Friedman S . Frailty and Short-Term Outcomes in Patients With Hip Fracture. Geriatr Orthop Surg Rehabil. 2015; 6(3):209-14. PMC: 4536514. DOI: 10.1177/2151458515591170. View

Cooper Z, Rogers Jr S, Ngo L, Guess J, Schmitt E, Jones R . Comparison of Frailty Measures as Predictors of Outcomes After Orthopedic Surgery. J Am Geriatr Soc. 2016; 64(12):2464-2471. PMC: 5173406. DOI: 10.1111/jgs.14387. View

10.

Lin H, Watts J, Peel N, Hubbard R . Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016; 16(1):157. PMC: 5007853. DOI: 10.1186/s12877-016-0329-8. View

11.

Ali Khan S, Chua H, Hirubalan P, Karthekeyan R, Kothandan H . Association between frailty, cerebral oxygenation and adverse post-operative outcomes in elderly patients undergoing non-cardiac surgery: An observational pilot study. Indian J Anaesth. 2016; 60(2):102-7. PMC: 4787120. DOI: 10.4103/0019-5049.176278. View

12.

Makary M, Segev D, Pronovost P, Syin D, Bandeen-Roche K, Patel P . Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010; 210(6):901-8. DOI: 10.1016/j.jamcollsurg.2010.01.028. View

13.

Morley J, Vellas B, Abellan van Kan G, Anker S, Bauer J, Bernabei R . Frailty consensus: a call to action. J Am Med Dir Assoc. 2013; 14(6):392-7. PMC: 4084863. DOI: 10.1016/j.jamda.2013.03.022. View

14.

Chandoo A, Chi C, Ji W, Huang Y, Chen X, Zhang W . Gait speed predicts post-operative medical complications in elderly gastric cancer patients undergoing gastrectomy. ANZ J Surg. 2017; 88(7-8):723-726. DOI: 10.1111/ans.14325. View

15.

Shamliyan T, Talley K, Ramakrishnan R, Kane R . Association of frailty with survival: a systematic literature review. Ageing Res Rev. 2012; 12(2):719-36. DOI: 10.1016/j.arr.2012.03.001. View

16.

Sundermann S, Dademasch A, Rastan A, Praetorius J, Rodriguez H, Walther T . One-year follow-up of patients undergoing elective cardiac surgery assessed with the Comprehensive Assessment of Frailty test and its simplified form. Interact Cardiovasc Thorac Surg. 2011; 13(2):119-23. DOI: 10.1510/icvts.2010.251884. View

17.

Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M146-56. DOI: 10.1093/gerona/56.3.m146. View

18.

Partridge J, Harari D, Dhesi J . Frailty in the older surgical patient: a review. Age Ageing. 2012; 41(2):142-7. DOI: 10.1093/ageing/afr182. View

19.

Singh M, Rihal C, Lennon R, Spertus J, Nair K, Roger V . Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization. Circ Cardiovasc Qual Outcomes. 2011; 4(5):496-502. PMC: 4182923. DOI: 10.1161/CIRCOUTCOMES.111.961375. View

20.

Chung C, Wu C, Jones M, Kato T, Dam T, Givens R . Reduced handgrip strength as a marker of frailty predicts clinical outcomes in patients with heart failure undergoing ventricular assist device placement. J Card Fail. 2014; 20(5):310-5. PMC: 4284074. DOI: 10.1016/j.cardfail.2014.02.008. View