The Impact of Frailty on 30-day Post-Elective Surgery Complications in Elderly Patients: a Prospective Cohort Study

Authors

  • Noto Dwimartutie Division of Geriatric, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - dr. Cipto Mangunkusumo General Hospital
  • Popy Yusnidar Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Susilo Chandra Department of Anesthesiology and Intensive Care, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Kuntjoro Harimurti Division of Geriatric, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Clinical Epidemiology and Evidence-based Medicine Unit, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Keywords:

frailty, post-surgery complication, elective surgery, elderly

Abstract

Background: late-life surgery poses a greater risk for complications and a higher mortality rate. Frailty has been noted to predict adverse outcomes after surgery in elderly patients. We aimed to investigate the impact of frailty on 30-day post-elective surgery complications in elderly patients. Methods: this prospective cohort study was conducted based on data collected from patients undergoing elective surgery in Cipto Mangunkusumo Hospital, Indonesia. Frailty was assessed using the Frailty Index 40 items, and 30-day post-surgery complications were assessed using Clavien-Dindo classification. Multivariate logistic regression analysis was performed to determined adjusted relative risk (RR) of the development of 30-day post-surgery complications. Results: a total of 180 subjects were enrolled in the study, with average age of 67.1 (SD 6.06) years old. More than half of the subjects fell into pre-frail category (55.6%), followed by frail (26.7%) and fit (17.7%) respectively. About 21.1% experienced complications within 30 days post-surgery. Frail subjects (41.7%) showed higher incidence of complications compared to the pre-frail (15%) and fit (9.4%) group. Multivariate analysis revealed that adjusted RR in the frail group accounted for 4.58 (95% CI 1.8-8.12), considering the surgical severity as a confounding factor. No significant difference in the incidence of complications was observed between the pre-frail and fit groups, despite the pre-frail group having a higher complication rate. Conclusion:being frail increases the risk of 30-day post-elective surgery complications in elderly patients. 

References

Statistik penduduk lanjut usia 2017 [Internet]. Badan Pusat Statistik 2017 [cited January 15th 2018]. Available from: https://www.bps.go.id/publication/download.html.

Deiner S, Westlake B, Dutton RP. Patterns of surgical care and complications in elderly adults. J Am Geriatr Soc. 2014;62(5):829-35.

Easterlin MC, Chang DG, Talamini M, Chang DC. Older age increases short-term surgical complications after primary knee arthroplasty. Clin Orthop Relat Res. 2013;471(8):2611-20.

Amrock LG, Deiner S. The implication of frailty on preoperative risk assessment. Curr Opin Anaesthesiol. 2014;27(3):330-5.

Partridge JSL, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age and Ageing. 2012;41(2):142-7.

Tan KY, Kawamura YJ, Tokomitsu A, Tang T. Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg. 2012;204(2):139-43.

Kristjansson SR, Nesbakken A, Jordhøy MS, et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol. 2010;76(3):208-17.

Green P, Arnold SV, Cohen DJ, et al. Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER trial). The Am J Cardiol. 2015;116(2):264-9.

Partridge JS, Fuller M, Harari D, Taylor PR, Martin FC, Dhesi JK. Frailty and poor functional status are common in arterial vascular surgical patients and affect postoperative outcomes. Int J Surg. 2015;18:57-63.

Kistler EA, Nicholas JA, Kates SL, Friedman SM. Frailty and short-term outcomes in patients with hip fracture. Geriatr Orthop Surg Rehabil. 2015;6(3):209-14.

Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62(7):738-43.

Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62(7):738-43.

Mitnitski AB, Song X, Rockwood K. The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci. 2004;59(6):M627-32.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.

Donati A, Ruzzi M, Adrario E, Pelaia P, Coluzzi F, Gabbanelli V, et al. A new and feasible model for predicting operative risk. Br J Anaesth. 2004;93(3):393-9.

Zhang J, Yu KF. What’s the relative risk?A method of correcting the odds ratio in cohort studies of common outcomes. J AMA. 1998;280(19):1690-1.

Downloads

Published

2020-12-28

How to Cite

Dwimartutie, N., Yusnidar, P., Chandra, S., & Harimurti, K. (2020). The Impact of Frailty on 30-day Post-Elective Surgery Complications in Elderly Patients: a Prospective Cohort Study. Acta Medica Indonesiana, 52(4), 344. Retrieved from http://www.actamedindones.org/index.php/ijim/article/view/1573

Issue

Vol. 52 No. 4 (2020): Acta Medica Indonesiana

Section

ORIGINAL ARTICLE

License

Copyright

The authors who publish in this journal agree to the following requirements:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a  Creative Commons Attribution 4.0 International License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) before and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. (See The Effect of Open Access)

Privacy Statement

The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.