Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery

Binru Han, Qiuping Li, Xi ChenDepartment of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of ChinaPurpose: To determine the association between frailty and postoperative complications in elderly Chinese patients and to determine whether addition of frailt...

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Autores principales:	Han B, Li Q, Chen X
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	frailty assessment risk assessment tool surgery postoperative complication Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/a2a9ef1e5123408ab30cdf7176cddcf9
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spelling	oai:doaj.org-article:a2a9ef1e5123408ab30cdf7176cddcf92021-12-02T08:14:21ZFrailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery1178-1998https://doaj.org/article/a2a9ef1e5123408ab30cdf7176cddcf92019-05-01T00:00:00Zhttps://www.dovepress.com/frailty-and-postoperative-complications-in-older-chinese-adults-underg-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Binru Han, Qiuping Li, Xi ChenDepartment of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of ChinaPurpose: To determine the association between frailty and postoperative complications in elderly Chinese patients and to determine whether addition of frailty assessment improves the predictive ability of the American Society of Anesthesiologists (ASA) score, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), and Estimation of Physiologic Ability and Surgical Stress (E-PASS) score.Patients and methods: A prospective cohort study was conducted in a tertiary hospital. Elderly patients undergoing major thoracic or abdominal surgery were included. Frailty phenotype and ASA, POSSUM, and E-PASS scores were assessed. Demographic, preoperative, and surgical variables were extracted from medical records. Primary outcome measure was in-hospital Clavien-Dindo ≥ grade II complications. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves were used to explore the predictive ability of frailty.Results: Prevalence of frailty was 26.12%. Significant differences were observed between the frail and non-frail groups with respect to age, Activities of Daily Living, Charlson Comorbidity Index, respiratory function, presence of malignancy, serum albumin, prealbumin, and hemoglobin levels (P<0.05). ASA, POSSUM, and E-PASS scores were higher in the frail group. After adjusting for all covariates, frailty was significantly associated with postoperative complications in hospital [odds ratio: 16.59, 95% CI: 4.56–60.40, P<0.001]. The area under the curve (AUC) for frailty was 0.762 (95% CI: 0.703–0.814). The AUC for ASA, POSSUM, and E-PASS for prediction of complications was 0.751 (95% CI: 0.692–0.804), 0.762 (95% CI: 0.704–0.814), and 0.824 (95% CI: 0.771–0.870), respectively. Addition of frailty assessment increased the AUC to 0.858 (95% CI: 0.808–0.899), 0.842 (95% CI: 0.790–0.885), and 0.854 (95% CI: 0.803–0.896), respectively.Conclusion: Frailty is an effective predictor of postoperative complications in elderly Chinese patients undergoing major thoracic and abdominal surgery. Frailty assessment can improve the predictive ability of current surgical risk assessment tools. Frailty phenotype should be considered perioperatively. Frailty assessment could also expand the scope for nurses to evaluate patients for safety management.Keywords: frailty assessment, risk assessment tool, surgery, postoperative complicationHan BLi QChen XDove Medical Pressarticlefrailty assessmentrisk assessment toolsurgerypostoperative complicationGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 14, Pp 947-957 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	frailty assessment risk assessment tool surgery postoperative complication Geriatrics RC952-954.6
spellingShingle	frailty assessment risk assessment tool surgery postoperative complication Geriatrics RC952-954.6 Han B Li Q Chen X Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery
description	Binru Han, Qiuping Li, Xi ChenDepartment of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of ChinaPurpose: To determine the association between frailty and postoperative complications in elderly Chinese patients and to determine whether addition of frailty assessment improves the predictive ability of the American Society of Anesthesiologists (ASA) score, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), and Estimation of Physiologic Ability and Surgical Stress (E-PASS) score.Patients and methods: A prospective cohort study was conducted in a tertiary hospital. Elderly patients undergoing major thoracic or abdominal surgery were included. Frailty phenotype and ASA, POSSUM, and E-PASS scores were assessed. Demographic, preoperative, and surgical variables were extracted from medical records. Primary outcome measure was in-hospital Clavien-Dindo ≥ grade II complications. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves were used to explore the predictive ability of frailty.Results: Prevalence of frailty was 26.12%. Significant differences were observed between the frail and non-frail groups with respect to age, Activities of Daily Living, Charlson Comorbidity Index, respiratory function, presence of malignancy, serum albumin, prealbumin, and hemoglobin levels (P<0.05). ASA, POSSUM, and E-PASS scores were higher in the frail group. After adjusting for all covariates, frailty was significantly associated with postoperative complications in hospital [odds ratio: 16.59, 95% CI: 4.56–60.40, P<0.001]. The area under the curve (AUC) for frailty was 0.762 (95% CI: 0.703–0.814). The AUC for ASA, POSSUM, and E-PASS for prediction of complications was 0.751 (95% CI: 0.692–0.804), 0.762 (95% CI: 0.704–0.814), and 0.824 (95% CI: 0.771–0.870), respectively. Addition of frailty assessment increased the AUC to 0.858 (95% CI: 0.808–0.899), 0.842 (95% CI: 0.790–0.885), and 0.854 (95% CI: 0.803–0.896), respectively.Conclusion: Frailty is an effective predictor of postoperative complications in elderly Chinese patients undergoing major thoracic and abdominal surgery. Frailty assessment can improve the predictive ability of current surgical risk assessment tools. Frailty phenotype should be considered perioperatively. Frailty assessment could also expand the scope for nurses to evaluate patients for safety management.Keywords: frailty assessment, risk assessment tool, surgery, postoperative complication
format	article
author	Han B Li Q Chen X
author_facet	Han B Li Q Chen X
author_sort	Han B
title	Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery
title_short	Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery
title_full	Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery
title_fullStr	Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery
title_full_unstemmed	Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery
title_sort	frailty and postoperative complications in older chinese adults undergoing major thoracic and abdominal surgery
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/a2a9ef1e5123408ab30cdf7176cddcf9
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_version_	1718398618288783360

Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery

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