Key result
Frailty as measured by the FRAIL scale was associated with a 6.62-fold increased odds of 30-day mortality compared to nonfrail older surgical patients.
Why the study?
Existing frailty screening tools require in-person evaluation, whereas the association between the brief, potentially virtual FRAIL scale and postoperative outcomes in older surgical patients was unknown.
Does frailty as assessed by the FRAIL scale predict mortality and postoperative outcomes in older surgical patients?
Meta-Analysis (n=4,479)
Does frailty as assessed by the FRAIL scale predict mortality and postoperative outcomes in older surgical patients?
The FRAIL scale is a useful and rapid preoperative screening tool that significantly predicts 30-day mortality, 6-month mortality, postoperative complications, and delirium in older surgical patients.
Supports preoperative frailty screening in older surgical patients; leaves open whether targeted interventions reduce mortality.
BACKGROUND: Several frailty screening tools have been shown to predict mortality and complications after surgery. However, these tools were developed for in-person evaluation and cannot be used during virtual assessments before surgery. The FRAIL (fatigue, resistance, ambulation, illness, and loss of weight) scale is a brief assessment that can potentially be conducted virtually or self-administered, but its association with postoperative outcomes in older surgical patients is unknown. The objective of this systematic review and meta-analysis (SRMA) was to determine whether the FRAIL scale is associated with mortality and postoperative outcomes in older surgical patients. METHODS: Systematic searches were conducted of multiple literature databases from January 1, 2008, to December 17, 2022, to identify English language studies using the FRAIL scale in surgical patients and reporting mortality and postoperative outcomes, including postoperative complications, postoperative delirium, length of stay, and functional recovery. These databases included Medline, Medline ePubs/In-process citations, Embase, APA (American Psychological Association) PsycInfo, Ovid Emcare Nursing, (all via the Ovid platform), Cumulative Index to Nursing and Allied Health Literature (CINAHL) EbscoHost, the Web of Science (Clarivate Analytics), and Scopus (Elsevier). The risk of bias was assessed using the quality in prognosis studies tool. RESULTS: A total of 18 studies with 4479 patients were included. Eleven studies reported mortality at varying time points. Eight studies were included in the meta-analysis of mortality. The pooled odds ratio (OR) of 30-day, 6-month, and 1-year mortality for frail patients was 6.62 (95% confidence interval [CI], 2.80-15.61; P < .01), 2.97 (95% CI, 1.54-5.72; P < .01), and 1.54 (95% CI, 0.91-2.58; P = .11), respectively. Frailty was associated with postoperative complications and postoperative delirium, with an OR of 3.11 (95% CI, 2.06-4.68; P < .01) and 2.65 (95% CI, 1.85-3.80; P < .01), respectively. The risk of bias was low in 16 of 18 studies. CONCLUSIONS: As measured by the FRAIL scale, frailty was associated with 30-day mortality, 6-month mortality, postoperative complications, and postoperative delirium.
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Gong et al. (2022) conducted a meta-analysis in Older surgical patients (n=4,479). Frailty assessed by the FRAIL scale vs. Nonfrail patients was evaluated on 30-day mortality (OR 6.62, 95% CI 2.80-15.61, p=<0.01). Frailty as measured by the FRAIL scale was associated with a 6.62-fold increased odds of 30-day mortality compared to nonfrail older surgical patients.
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