J. McDonnell1, P. R. Varley1, D. E. Hall1,2, J. W. Marsh1, D. A. Geller1, A. Tsung1 1University Of Pittsburgh,General Surgery,Pittsburgh, PA, USA 2VA Pittsburgh Healthcare System,General Surgery,Pittsburgh, PA, USA
Introduction: Frailty defines a phenotype of functional decline that places patients at risk for death and disability, and the American College of Surgeons and American Geriatric Society have joint guidelines which recommend implementation of a frailty assessment for aging patients. Though various instruments for measuring patient frailty have been described in the literature, it is unclear which is the most appropriate for routine screening of surgical patients. The goal of this project was to compare assessments from three separate frailty instruments in a cohort of surgical patients in order to inform the development of a robust, clinically feasible frailty assessment for surgical patients.
Methods: Demographic and medical history for all new patients evaluated at the Liver Cancer Center of UPMC was collected by patient-completed questionnaire and verified by a research associate (RA). Patients were then assessed for functional measures of frailty including extended timed up-and-go (eTUG), walking speed, grip strength, and Mini-Cog. Information from this assessment was then used to calculate scores for the Fried Frailty Phenotype (FF), Edmonton Frail Scale (EFS), and Risk Analysis Index (RAI). Frailty was defined as FF ≥ 3, EFS ≥ 8, or RAI ≥ 21.
Results: As part of a pilot project, 127 patients were evaluated. 64 (52.0%) of the patients were male. The cohort had a mean age of 62.9±15.0 years, and mean BMI of 29.4±6.4. Median scores for the RAI were 10 [IQR 7-17], 3 [IQR 2-5] for the EFS, and 1 [IQR 0-2] for FF. With respect to frailty, 36 (28.4%) of the patients were frail with respect to any of the three measures of frailty. 12 (9.5%) of patients were rated frail by the EFS, while 21 (16.5%) of patients were rated frail by the FF and 23 (18.1%) by the RAI. 20 patients (15.8%) were classified frail by only one measure, 12 (9.5%) by two measures, and only 4 (2.2%) by all 3 scales. Inter-rater agreement between the three scales was fair (κ = 0.33, p <0.001). Figure 1 demonstrates the concordance of measures among all three instruments, and demonstrates that choosing only one of the EFS, RAI or FF would have failed to recognize 16 (44.4%), 10 (27.8%), and 12 (33.3%) of the potentially frail patients respectively.
Conclusion: The results of this pilot project suggest that it is feasible to implement a routine frailty screening process in a busy surgical clinic. Utilizing only single frailty instrument to evaluate patients may lead to an underestimate of frailty in surgical populations. Future work should focus on creation of a frailty screening process developed specifically for surgical patients and linked to surgical outcomes.
