A Quicker, Possibly Better Measurement of Frailty Before Surgery

Young or old, one of the biggest concerns about having surgery is how well you are going to do after. Surgery is meant to cure a problem or to improve quality of life, but the outcome isn't always what we may hope for. While some people breeze through post-operative recovery, others struggle and have set backs. In some cases, the surgery and its effects start a downward spiral that is hard to stop.

Seniors are frequently considered to be at risk for surgical complications. Many have other medical problems, may be taking prescription medications, and may not have a support system at home to help them when they recover. However, it's not just seniors who can be at risk for post-surgery difficulties - young adults can be just as well.

Frailty tests are meant to help physicians understand which patients are at highest risk for complications after surgery. The most common test is the Fried Frailty Criteria.  "Frail means they don't have the physiologic reserve to bounce back after the operation, so they start down a path that they may not easy recover from," coauthor Kenneth Ogan, MD, said in a press release.

This assessment looks at five distinct features: shrinking (has the patient had any unexplained or unintentional weight loss of 10 or more pounds over the past year), grip strength, exhaustion (how tired is the patient?), activity level, and walking speed (how quickly can the patient walk 15 feet?). The assessment can take about 10 minutes to complete.

A study just published in the Journal of the American College of Surgeons looked patients who had major abdominal surgery and the researchers examined if there was a better way to assess the patients that was also less time consuming.

Of the 351 patients in the study, 36.7% of them had experienced a post-operative complication within 30 days of the surgery. Almost 25% were minor complications, but just over 14% were major, such as wound infections, pneumonia, and stroke. Some died.

The researchers went back and to see what the prediction would be if the testers had used just two of the five frailty factors, grip strength and weight loss. They found that the prediction results of post-surgery outcomes were the same using the two assessments as with the full five-point assessment.

The researchers then added two other factors (the patients' physical status for anesthesia and hemoglobin levels in the blood), and the ability to predict complications was better than with just the frailty test.

The advantage to this finding is that the preoperative testing for just two frailty factors, plus the physical status and blood tests cuts down the testing time to less than a minute, the researchers said. In addition, if there are issues like poor grip strength and weight loss, it might be possible to address these problems before surgery, perhaps reducing the risk of complications after.