Frailty a bigger predictor of post-surgery outcomes than age

UAlberta researchers find that frail or vulnerable elderly surgical patients were four times more at risk of readmission.

Being frail or vulnerable were stronger predictors of post-operative outcomes than age, according to a comprehensive study by University of Alberta researchers.

"One-third of patients 65-plus who underwent emergency abdominal surgery were either readmitted to hospital or died six months later. That high number alone surprised us," said Rachel Khadaroo, a surgeon and an associate professor of surgery in the U of A's Faculty of Medicine & Dentistry, and a senior author on the study.

"And while you might suspect frail patients, those who need help with one or more daily activity, might have poor outcomes, this was also true of 'vulnerable' patients-those who have an illness but no apparent disability and who live independently," added Jenelle Pederson, a medical student at the University of Calgary and the study's co-lead author.

Compared with older patients who are well, frail and vulnerable older patients were four times more likely to be readmitted or die within 30 days after discharge following surgery, according to the study. This heightened risk persisted up to six months after discharge back into the community.

Until now, there has been very little data on frail, elderly patients and surgical outcomes.

"For the first time, this study has identified two elderly patient populations at risk of poor outcomes following surgery, and we need to develop ways to improve the outcomes of those patients," said Khadaroo.

Not only are hospital readmissions expensive, they are an important indicator for surgical care, she added.

"When you consider the fact elderly people are the fastest growing population in Canada-in 2015, the number of people over the age of 65 outnumbered those under 15-this area of research is of vital importance for improving health outcomes and managing cost of care."

Next steps

Assessing for frailty or vulnerability is not currently a routine practice in surgical centres in Canada, pointed out Khadaroo.

"In order to begin identifying those patients who are at risk, we are recommending that surgical centres use validated tools to identify elderly patients who are either frail or vulnerable," she said.

Khadaroo's research group is also currently studying a new model of care called Elder-friendly Approaches to the Surgical Environment (EASE).

"Our hope is that it will change how elderly frail and vulnerable patients are cared for before and after surgery with the goal of improving outcomes," she said.

EASE includes an interdisciplinary team-based care model including a geriatrician, and comfort rounds with early mobilization, delirium prevention and management, optimal nutrition and prevention of post-operative complications, as well as early discharge planning that includes family, social worker, care co-ordinator and surgical team.

"Impact of Frailty on Outcomes After Discharge in Older Surgical Patients: A Prospective Cohort Study" was funded by a grant from the Alberta Health Services-Alberta Innovates Health Solutions Partnership for Research and Innovation in the Health System, and published in the Canadian Medical Association Journal. The study was a partnership between Alberta Health Services' Strategic Clinical Networks and investigators from across the province.