Frailty in peri-operative patients in three South African Academic Hospitals

Abstract

Background Frailty is a state characterised by diminished physiological reserve that leaves one vulnerable to external stressors and delays recovery thereof. Frailty assessments are proving to be more valuable in predicting poor perioperative outcomes than other well-known peri-operative risk assessment tools. There are very few studies that have been done using validated frailty assessment tools to assess the prevalence of frailty in South Africa and none have assessed the intraoperative implications of frailty in a surgical population. Methods We prospectively enrolled 299 participants aged 18 to 90 years undergoing various types of elective surgery between November 2016 and March 2017 in three South African Academic Hospitals. Frailty was assessed using the nine-point Clinical Frailty Scale (CFS) and was defined as a score of five or more. The CFS score, demographic and clinical data were documented by the anaesthetists assigned to the respective elective lists. The primary outcome measure was intraoperative complications (hypotension, desaturation, need for vasopressors and blood transfusion). We additionally compared the association between participant’s comorbidities and frailty as well as the association between the CFS and the American Society of Anaesthesiologists Physical Status (ASA-PS) scores. Results Two hundred and ninety-nine participants were included in the study. The mean age was 50.6 years (SD15.8). One hundred and fifty-six (52%) were women. Sixty-seven (22%) were classified as frail. The frail group had significantly higher incidences of hypotension (odds ratio [OR] 1.87, 95% confidence interval [CI]1.083-3.259; p=0.02), desaturation (OR 3.79, 95 % CI 1.367-10.54; p=0.01), need for vasopressors (OR 2.81, 95 % CI 1.607-4.912; p=0.00) and blood transfusion (OR 3.26, 95 % CI 1.138-9.368; p=0.02). On multivariable logistic regression analysis, adjusting for factors related to frailty such as age, gender and comorbidities, desaturation was significantly associated with frailty (Adjusted OR [AOR] 4.21, 95% CI 1.31-13.53; p=0.01). The frail were also more likely to require blood transfusion (AOR 5.36, 95% V CI 1.50-19.16; p=0.01). The frail were older and had more comorbidities. Higher ASA-PS scores were also strongly associated with frailty. Conclusion The prevalence of frailty was high among surgical patients. Consistent with other studies frailty was associated with older age and multiple comorbidities. The association between frailty and intraoperative complications found in this study may indicate and help inform areas of further research.