Key result
Preoperative vulnerability, defined as an Edmonton Frailty Scale score of 6 or higher, was independently associated with a significantly increased risk of postoperative delirium (OR 3.49) in older adults undergoing elective surgery.
Why the study?
Although phenotypic frailty predicts postoperative delirium well, the Edmonton Frailty Scale offers higher feasibility in surgical settings, prompting evaluation of its association with postoperative delirium in older elective surgical patients.
Does EFS-assessed vulnerability predict postoperative delirium in older adults undergoing elective surgery?
Cohort (n=324)
No
Does EFS-assessed vulnerability predict postoperative delirium in older adults undergoing elective surgery?
Odds Ratio: 3.49 (95% CI 1.06–11.54)
Absolute Event Rate: 12.1% vs 2.1%
p-value: p=0.04
The Edmonton Frailty Scale is a feasible preoperative screening tool that independently predicts postoperative delirium in older adults undergoing lower-risk elective surgery.
Supports EFS screening for preoperative delirium risk stratification; leaves open whether targeted interventions improve outcomes.
Background: Frailty has been associated with postoperative delirium (POD). Studies suggest that the Fried phenotype has a stronger association with POD than the Edmonton Frailty Scale (EFS) criteria. Although phenotypic frailty is recognized as a good predictor of delirium, the EFS has higher ratings for feasibility in the surgical setting. Thus, our aim was to determine the association between EFS-assessed vulnerability and POD in an elective surgical population of older adults. A secondary aim was to determine which domains assessed by the EFS were closely associated with POD. Methods: After IRB approval was received, electronic medical records of surgical patients at our institution were downloaded from 12/1/2018 to 3/1/2020. Inclusion criteria included age ≥65 years, preoperative EFS assessment within 6 months of surgery, elective surgery not scheduled for intensive care unit (ICU) stay but followed by at least 1 day postoperative stay, and at least two in-hospital evaluations with the 4 A's test (arousal, attention, abbreviated mental test-4, acute change [4AT]) on the surgical ward. Vulnerability was determined by EFS score ≥6. Patients were stratified into two groups according to highest postoperative 4AT score: 0-3 (no POD) and ≥4 (POD). Odds of POD associated with EFS score ≥6 were evaluated by using logistic regression adjusted for potential confounders. Results: The dataset included 324 patients. Vulnerability was associated with higher incidence of POD ( P =0.0007). EFS ≥6 was consistently associated with POD in all bivariate models. Vulnerability predicted POD in multivariable modeling (OR 95%CI = 3.5 [1.1-11.5]; P =0.04). Multivariable analysis of EFS domains revealed an overall trend in which higher scores per domain had a higher odds for POD. The strongest association occurred with presence of incontinence (OR 95%CI = 3.8 [1.2-11.0]; P =0.02). Conclusions: EFS criteria for vulnerability predict POD in older, non-ICU patients undergoing elective surgery.
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Sieber et al. (2022) conducted a cohort in Postoperative delirium (n=324). Edmonton Frailty Scale (EFS) score ≥ 6 (Vulnerability) vs. EFS score < 6 was evaluated on Postoperative delirium (highest postoperative 4AT score ≥ 4) (OR 3.49, 95% CI 1.06-11.54, p=0.04). Preoperative vulnerability, defined as an Edmonton Frailty Scale score of 6 or higher, was independently associated with a significantly increased risk of postoperative delirium (OR 3.49) in older adults undergoing elective surgery.
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