Clinical science
Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized

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Abstract

Background

The clinical syndrome of frailty identified through the assessment of weight loss, gait speed, grip strength, physical activity, and physical exhaustion has been used to identify patients with reduced reserves. We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients.

Methods

A prospective study was conducted at 2 centers (Singapore and Japan). All patients over 75 years of age undergoing colorectal resection were assessed for the presence of the syndrome of frailty. All these patients had already had their comorbidities optimized for surgery. The outcome measure was postoperative major complications (defined as Clavien-Dindo type II and above complications).

Results

Eighty-three patients were studied from February 2008 to April 2010. The mean age was 81.5 years (range 75–93 years). The mean comorbidity index was 3.37 (range 0–11). Twenty-six (31.3%) patients were an American Society of Anesthesiologists (ASA) score of 3 and above. Chi-square analysis revealed that the odds ratio of postoperative major complications was 4.083 (95% confidence interval, 1.433–11.638) when the patient satisfied the criteria for frailty. Albumin <35, ASA >3, comorbidity index >5, and Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scores were not predictive of postoperative major complications.

Conclusions

Preliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity. Frailty can be used to identify elderly patients needing further optimization before major surgery.

Section snippets

Methods

A prospective study was conducted at 2 centers (Singapore and Japan). Consecutive patients over 75 years of age undergoing elective colorectal resection surgery were included in the study. The age cutoff of 75 years was chosen because this age is in line with what we have defined as elderly surgical patients in our other studies.10 Patients over the age of 75 had been shown in some studies to have a higher risk of postoperative complications.11 Patients who declined data collection were

Results

A total of 83 patients over 75 years of age who underwent major colorectal surgery were studied prospectively. Patient demographics are shown in Table 2. More than 90% of patients had associated comorbidities. Nearly one quarter of the patients were positive for the frailty syndrome according to the criteria proposed by Fried et al.9

Complication and mortality rates are also reflected in Table 2. There were an equal number of surgical complications and medical complications. Three patients

Comments

Risk stratification for elderly patients undergoing major surgery is important for surgical planning. Only with proper risk stratification can decisions be made with regard to whether to perform surgery at all, the type of surgery, and the timing of the surgery. Risk stratification will also identify patients who require a period of optimization before surgery. Risk stratification is performed by assessing comorbidities and investigations of biochemical and physiological markers. Because the

Conclusions

Our preliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity. Frailty can be used to identify elderly patients needing further optimization before major surgery.

Acknowledgments

The authors thank Senior Staff Nurse Phyllis Tan, Khoo Teck Puat Hospital, who has contributed to the management of the collected data and the design of the tables.

References (20)

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