The prevalence and trajectory of frailty in older surgical patients: A longitudinal multicentre cohort study

IF 4.7 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine Pub Date : 2025-09-01 DOI:10.1016/j.accpm.2025.101582

Yu Tong Lu , Ellene Yan , Yasmin Alhamdah , Paras Kapoor , Leif Erik Lovblom , Aparna Saripella , Jean Wong , Frances Chung

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引用次数: 0

Abstract

Background

Frailty is a state of increased vulnerability and decreased physiological reserve, which can reduce one’s capacity to cope with external stressors such as a major surgery. We aimed to (1) investigate the preoperative and postoperative prevalence of frailty in older surgical patients; and (2) evaluate preoperative risk factors associated with postoperative frailty.

Methods

This multicentre prospective study included 307 non-cardiac surgical patients aged ≥65 years. Clinical frailty was assessed online using the five-item FRAIL scale (Fatigue, Resistance, Ambulation, Illness, weight-Loss) preoperatively and postoperatively at 30, 90, and 180 days. Trajectories of FRAIL scores were assessed with linear mixed-effects models, stratified by preoperative frailty. Preoperative risk factors associated with frailty at 180 days were explored by logistic regression.

Results

Preoperatively, 36% of patients were robust, 52% were prefrail, and 12% were frail. Frail patients experienced a significant improvement in frailty by 90 and 180 days. Prefrail patients experienced a transient worsening of frailty level with subsequent improvement by 180 days. Robust patients experienced similar worsening in frailty but remained clinically robust, despite a small absolute difference in FRAIL score. Preoperative frailty and functional disability were both associated with greater odds of 180-day frailty (aOR 2.65, 95% CI [1.51, 4.97] and aOR 4.71, 95% CI [1.41, 15.65], respectively).

Conclusions

The prevalence of preoperative prefrailty and frailty was high among older surgical patients. A high preoperative FRAIL score and severe functional disability were associated with greater odds of postoperative 180-day frailty. Preoperative frailty assessment can risk-stratify patients and inform postoperative targets.

Registration

The trial was registered on www.clinicaltrials.gov on April 7, 2021 (NCT04850833).

Abstract Image

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老年外科患者虚弱的患病率和发展轨迹：一项纵向多中心队列研究。

背景：虚弱是一种脆弱性增加和生理储备减少的状态，它可以降低一个人应对外部压力的能力，如大手术。我们的目的是(1)调查老年外科患者术前和术后的虚弱患病率；(2)评估术前与术后虚弱相关的危险因素。方法：本多中心前瞻性研究纳入307例年龄≥65岁的非心脏手术患者。术前和术后30,90和180天，使用五项虚弱量表（疲劳，抵抗力，行走，疾病，体重减轻）在线评估临床虚弱。虚弱评分的轨迹用线性混合效应模型进行评估，并按术前虚弱程度分层。通过logistic回归分析术前180天虚弱的相关危险因素。结果：术前36%的患者身体健壮，52%的患者体弱，12%的患者体弱。体弱多病的患者在90天和180天内的虚弱程度有显著改善。体弱多病患者经历短暂的衰弱程度恶化，随后在180天内得到改善。健壮的患者在虚弱方面经历了类似的恶化，但临床仍然健壮，尽管虚弱评分有很小的绝对差异。术前虚弱和功能障碍均与180天虚弱的较大几率相关（分别为aOR 2.65, 95% CI[1.51, 4.97]和aOR 4.71, 95% CI[1.41, 15.65]）。结论：高龄手术患者术前易患和虚弱的发生率较高。术前虚弱评分高和严重的功能障碍与术后180天虚弱的可能性较大相关。术前虚弱评估可以对患者进行风险分层，并告知术后目标。注册：该试验于2021年4月7日在www.Clinicaltrials: gov上注册（NCT04850833）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anaesthesia Critical Care & Pain Medicine ANESTHESIOLOGY-

CiteScore

6.70

自引率

5.50%

发文量

150

审稿时长

18 days

期刊介绍： Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.