Frailty Status and Postoperative Outcomes of Elderly Patients Undergoing Elective Noncardiac Surgeries

INTRODUCTION: The population segment with the quickest rate of growth in majority of the developed countries is the elderly (≥65 years of age)(1). Frailty is a multifaceted state of decreased physical, physiological, and cognitive reserve that makes one more vulnerable to sickness, including critical illness(2). Data on the perioperative management of elderly patients undergoing major non-cardiac surgeries, as well as the connection between frailty and post-operative outcomes, are scarce in our nation. Hence, we evaluated the relation between the frailty and postoperative out comes in elderly population undergoing major noncardiac surgeries. OBJECTIVES: Our primary objective was to assess the association between frailty status and postoperative mortality. The secondary objectives were to assess the association of frailty status and need for unplanned ventilation in the postoperative period as well as postoperative ICU length of stay. PATIENTS AND METHODS: Patients undergoing major noncardiac surgeries (3 hours) who were 65 years and above were assessed and the frailty scores were obtained using the modified frailty index (Annexure 1). Based on the results of specificity of mFI in predicting survival of patients (78.76%), observed from the results of a pilot study, and with10% relative precision and 95% confidence, the number of patients who survived, by the end of follow up period, were 64. We included 203 patients in the study. ROC curve analysis was used to determine the cut-off values for mFI for predicting 28-day postoperative mortality. A p value of <0.05 was considered to be statistically significant. RESULTS: Among the 203 patients included 6 patients did not survive and 197 patients survived at the end of the follow up period (28 days). ROC curve analysis done showed an area under curve (AUC) to be 0.895 and a cut off mFI score of 4. Among the 203 patients that were analysed, the patients who had mFI ≥ 4 had a mortality of 12.8% with the other group (mFI< 4) had zero mortality at the end of 28 days (p value <.001). 11 patients required unplanned post op ventilation of which 6 patients had mFI score ≥4 (p = 0.011). The mean length of ICU stay was 1.67 days for the group with mFI score of <4 and it was 3.38 days for the group with mFI score of ≥ 4 (p <0.001). CONCLUSION: There was a significant statistical association between the modified frailty index and 28-day mortality in elderly undergoing major non cardiac surgeries. Patients with a modified frailty index (mFI) of ≥4 had higher odds for mortality (12.8%) when compared with the other group (mFI <4) which had zero mortality (p < 0.001). Thus, our results supported the association of mortality and frailty demonstrated by other studies in multiple settings(3,4,5). Frailty can be used as a tool that can be added to the standard preoperative risk assessment and guide pre-operative decisions for treatment approaches.