Surgeon Assessment of Frailty

Document Type

Abstract

Publication Title

Journal of the American College of Surgeons

Abstract

Introduction: Frailty describes a state of reduced physiologic reserve. A frailty index uses many variables to predict poor surgical outcomes. The purpose is to determine an agreement based on the surgeon’s determination and a validated frailty index score on frailty.

Methods: Patients aged 60 or older without recent traumatic brain injury or dementia who are seeking a general surgery consultation were recruited in the study. After obtaining the consent, the patients completed a validated frailty survey. The patient was frail with a frailty index score of 16 or greater. The surgeon determined the patient’s frailty based on the clinical history and physical exam.

Results: A total of 122 patients consented to participate in the study. The surgeons deemed 32 patients frail; the index determined 39 patients were frail (p=0.69). The average frailty score is 16.1 (±7.91), determined by the surgeons, compared with 21.9 (±4.15), determined by the frailty index (d=5.81; p=0.0001). Cohen’s Kappa statistic assessed an agreement between the surgeon’s determination and the frailty score, showing an agreement of 71.3% (k=0.307, 95% CI = 0.127-0.488; p<0.05), indicating fair agreement between the surgeon’s determination and the frailty index. The sensitivity and specificity are 46.2% and 83.1% for all patients. Among non-cancer patients (n=92), the sensitivity increases to 77.8%, and specificity remains the same.

Conclusion: There is fair agreement between the surgeon’s determination and the frailty index. However, this study demonstrates that using the clinical impression or the frailty index alone is insufficient to adequately predict post-surgical outcomes in the aging population.

DOI

10.1097/XCS.0000000000000828

Publication Date

11-2023

ISSN

1879-1190

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