Louis M Revenig1, Daniel J Canter2, Martha A Henderson1, Kenneth Ogan3, David A Kooby4, Shishir K Maithel4, Yuan Liu5, Sungjin Kim5, Viraj A Master6. 1. Department of Urology, Emory University School of Medicine, Atlanta, Georgia. 2. The Fox Chase Cancer Center, Einstein Health Network and The Urologic Institute of Southeastern Pennsylvania, Philadelphia, Pennsylvania. 3. Department of Urology, Emory University School of Medicine, Atlanta, Georgia; Department of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia. 4. Department of Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia. 5. Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia. 6. Department of Urology, Emory University School of Medicine, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia. Electronic address: vmaster@emory.edu.
Abstract
BACKGROUND: Frailty has gained recognition as an objective measure of a patient's physiologic reserve that ideally can replace the subjective biases of surgeons. In this study, we sought to examine the concordance between patient and attending surgeon perceptions of the patient's "fitness" before surgery. We then correlated these ratings with the patient's objective frailty scores. METHODS: Patients were prospectively enrolled from urology, general surgery, and surgical oncology clinics. Patients were asked to rate their ability to withstand the physical stress of the scheduled surgery on a visual analog scale. The operating surgeon then independently rated his assessment of the patient's ability to withstand surgery blinded to the patient's self assessment. RESULTS: A total of 203 patients were included. Median patient age and body mass index were 62 (range = 21-87) years and 28.1 kg/m(2) (18.0-53.1), respectively. The majority of patients were white (67%) and male (60.6%). A patients' self-assessment showed no correlation with their age; however, surgeons' ratings showed a positive correlation with patients' age. Patients' self-rated scores showed a positive correlation with their frailty score, although surgeons' ratings showed a stronger correlation. However, when stratified by age group, the positive correlation and predictive ability were lost (P value = 0.198). CONCLUSIONS: Although age is an established risk factor, our data demonstrate surgeons may place an overreliance on a patient's age in place of an objective measure of physiologic reserve. Conversely, patients tended to overestimate their ability to withstand the stress of surgery, possibly leading to unrealistic expectations of their recovery and outcomes.
BACKGROUND: Frailty has gained recognition as an objective measure of a patient's physiologic reserve that ideally can replace the subjective biases of surgeons. In this study, we sought to examine the concordance between patient and attending surgeon perceptions of the patient's "fitness" before surgery. We then correlated these ratings with the patient's objective frailty scores. METHODS:Patients were prospectively enrolled from urology, general surgery, and surgical oncology clinics. Patients were asked to rate their ability to withstand the physical stress of the scheduled surgery on a visual analog scale. The operating surgeon then independently rated his assessment of the patient's ability to withstand surgery blinded to the patient's self assessment. RESULTS: A total of 203 patients were included. Median patient age and body mass index were 62 (range = 21-87) years and 28.1 kg/m(2) (18.0-53.1), respectively. The majority of patients were white (67%) and male (60.6%). A patients' self-assessment showed no correlation with their age; however, surgeons' ratings showed a positive correlation with patients' age. Patients' self-rated scores showed a positive correlation with their frailty score, although surgeons' ratings showed a stronger correlation. However, when stratified by age group, the positive correlation and predictive ability were lost (P value = 0.198). CONCLUSIONS: Although age is an established risk factor, our data demonstrate surgeons may place an overreliance on a patient's age in place of an objective measure of physiologic reserve. Conversely, patients tended to overestimate their ability to withstand the stress of surgery, possibly leading to unrealistic expectations of their recovery and outcomes.
Authors: Casey M Hay; Heidi S Donovan; Grace B Campbell; Sarah E Taylor; Li Wang; Madeleine Courtney-Brooks Journal: Gynecol Oncol Date: 2018-11-28 Impact factor: 5.482
Authors: Mark K Ferguson; Katherine Thompson; Megan Huisingh-Scheetz; Jeanne Farnan; Joshua Hemmerich; Julissa Acevedo; Stephen Small Journal: Ann Thorac Surg Date: 2015-05-23 Impact factor: 4.330
Authors: Yibo Li; Jenelle L Pederson; Thomas A Churchill; Adrian S Wagg; Jayna M Holroyd-Leduc; Kannayiram Alagiakrishnan; Raj S Padwal; Rachel G Khadaroo Journal: CMAJ Date: 2018-02-20 Impact factor: 8.262
Authors: Meera R Chappidi; Max Kates; Hiten D Patel; Jeffrey J Tosoian; Deborah R Kaye; Nikolai A Sopko; Danny Lascano; Jen-Jane Liu; James McKiernan; Trinity J Bivalacqua Journal: Urol Oncol Date: 2016-02-15 Impact factor: 3.498
Authors: Harveshp Mogal; Sarah A Vermilion; Rebecca Dodson; Fang-Chi Hsu; Russell Howerton; Perry Shen; Clancy J Clark Journal: Ann Surg Oncol Date: 2017-01-05 Impact factor: 5.344
Authors: Katie S Murray; Megan Prunty; Alex Henderson; Tyler Haden; Naveen Pokala; Bin Ge; Mark Wakefield; Gregory F Petroski; David R Mehr; Robin L Kruse Journal: Urology Date: 2018-08-01 Impact factor: 2.649