Frailty patterns in European surgical patients: The FRAGILE multicentre prospective cohort.

IF 7.8 2区医学 Q1 ANESTHESIOLOGY

European Journal of Anaesthesiology Pub Date : 2026-10-22 DOI:10.1097/EJA.0000000000002495

Cesar Aldecoa, Andres Zorrilla-Vaca, Javier Ripolles-Melchor, Maurizio Cecconi, Orestis Ioannidis, Başak Ceyda Meço, Jan Benes, Nicolai Goettel, Nuria Martin, Nádia Tenreiro, Alexandra Wüest, Luigi Marano, Maria Sotiropoulou, Gabriel Putzer, Olga Smékalová, Seppe Koopman, Felix Wantang Baños, Ane Abad-Motos, Carlos Ferrando

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引用次数: 0

Abstract

Background: Frailty represents a multidimensional decline in physiological reserve that increases vulnerability to surgical stress. Its perioperative dynamics and association with outcomes across diverse surgical populations remain insufficiently characterised.

Objective: This study aimed to describe the prevalence of frailty before and after surgery and to evaluate its association with postoperative complications, mortality, and hospital length of stay.

Methods: We conducted a prospective, multicentre European cohort study including adults undergoing elective or emergency surgery under general or regional anaesthesia across 64 participating centres in 10 countries. Each centre contributed data from one to three predefined recruitment days between April 2021 and December 2022. Frailty was assessed preoperatively and at 30 days using the Rockwood Clinical Frailty Scale (CFS), the FRAIL questionnaire, and the Barthel Index. The primary outcome was the association between preoperative frailty and 30-day postoperative complications (Clavien-Dindo ≥ II); secondary outcomes included 30-day mortality, postoperative cognitive impairment, and new-onset frailty.

Results: Among 1472 patients (mean age 60.9 years; 52.9% male), preoperative frailty prevalence was 14.6% (FRAIL), 10.4% (CFS), and 10.4% (Barthel). Within 30 days, 11.9% of nonfrail patients became frail, increasing overall frailty prevalence to 21.2%. Postoperative complications occurred in 19.2% and mortality in 1.7%. Preoperative frailty was independently associated with complications: adjusted odds ratio (OR) 2.35 [95% confidence interval (CI) 1.53 to 3.60], P < 0.001); 30-day mortality OR 10.9 (95% CI 1.28 to 93.0), P = 0.029). Frailty was also associated with postoperative cognitive impairment: OR 3.47 (95% CI 1.98 to 6.08), P < 0.001).

Conclusions: Frailty is common among surgical patients, increases after surgery, and independently predicts postoperative complications and mortality. These findings highlight frailty as a dynamic and potentially modifiable marker of surgical vulnerability that should be routinely assessed and integrated into perioperative care.

Trial registration: ClinicalTrials.gov identifier: NCT04140370.

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欧洲外科病人的虚弱模式：脆弱的多中心前瞻性队列。

背景：虚弱表现为生理储备的多维度下降，增加了对手术压力的易感性。其围手术期动态和与不同手术人群预后的关系仍未充分表征。目的：本研究旨在描述手术前后虚弱的患病率，并评估其与术后并发症、死亡率和住院时间的关系。方法：我们在10个国家的64个参与中心进行了一项前瞻性、多中心的欧洲队列研究，包括在全身或局部麻醉下接受选择性或紧急手术的成年人。每个中心提供了2021年4月至2022年12月期间一到三个预定义招聘日的数据。术前和术后30天使用Rockwood临床虚弱量表（CFS）、虚弱问卷和Barthel指数评估虚弱程度。主要结局是术前虚弱和术后30天并发症之间的关系（Clavien-Dindo≥II）；次要结局包括30天死亡率、术后认知障碍和新发虚弱。结果：1472例患者（平均年龄60.9岁，男性52.9%），术前虚弱患病率为14.6%（体弱），10.4% （CFS）和10.4% （Barthel）。在30天内，11.9%的非虚弱患者变得虚弱，整体虚弱患病率增加到21.2%。术后并发症发生率19.2%，死亡率1.7%。术前虚弱与并发症独立相关：调整优势比（OR） 2.35[95%可信区间（CI） 1.53 ~ 3.60]， P结论：虚弱在手术患者中很常见，术后增加，独立预测术后并发症和死亡率。这些发现强调了脆弱作为一个动态的和潜在的可改变的手术易感性的标志，应该常规评估和纳入围手术期护理。试验注册：ClinicalTrials.gov标识符：NCT04140370。

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来源期刊

European Journal of Anaesthesiology 医学-麻醉学

CiteScore

6.90

自引率

11.10%

发文量

351

审稿时长

6-12 weeks

期刊介绍： The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).