Daniel I McIsaac1, Monica Taljaard2, Gregory L Bryson3, Paul E Beaulé4, Sylvain Gagne5, Gavin Hamilton5, Emily Hladkowicz6, Allen Huang7, John Joanisse8, Luke T Lavallée9, David MacDonald10, Husein Moloo11, Kednapa Thavorn2, Carl van Walraven12, Homer Yang13, Alan J Forster12. 1. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology, The Ottawa Hospital, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada. Electronic address: dmcisaac@toh.ca. 2. Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada. 3. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology, The Ottawa Hospital, Ottawa, ON, Canada. 4. Department of Surgery, Division of Orthopedic Surgery, University of Ottawa, Ottawa, ON, Canada. 5. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada. 6. Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, Ottawa, ON, Canada. 7. Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, Division of Geriatric Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. 8. Department of Family Medicine, Hôpital Montfort, Ottawa, ON, Canada. 9. Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. 10. Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada. 11. Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, Division of General Surgery, University of Ottawa, Ottawa, ON, Canada. 12. Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. 13. Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine, London, ON, Canada.
Abstract
BACKGROUND: Frailty is associated with early postoperative outcomes. How frailty influences long-term postoperative recovery is poorly described. Our objective was to evaluate the association of frailty with postoperative disability trajectories in the year after surgery. METHODS: Prespecified 1-yr follow-up of a prospective multicentre cohort study. Patients ≥65 yr were assessed for frailty before major elective noncardiac surgery (Clinical Frailty Scale [CFS] and Fried Phenotype [FP]). The primary outcome was patient-reported disability score (using the WHO Disability Assessment Schedule 2.0) at baseline, 30, 90, and 365 days after surgery. Repeated measures linear regression estimated the association of preoperative frailty with changes in disability scores over time, adjusted for procedure. Group-based trajectory modelling was used to identify subgroup trajectories of people with frailty. RESULTS: One-year follow-up was complete for 687/702 (97.9%) participants. Frailty was associated with a significant difference in disability trajectory (P<0.0001). Compared with baseline, people with frailty experienced a decrease in disability score at 365 days (CFS frailty: -7.3 points, 95% confidence interval [CI] -10.2 to -4.5); (FP frailty: -5.4 points, 95% CI -8.5 to -2.3); people without frailty had no significant change in their disability score from baseline (no CFS frailty: +0.8 points, 95% CI -1.7 to 3.2; no FP frailty: +1.1 points, 95% CI -3.5 to 1.3). More than one-third of people with frailty experienced an early increase in disability before achieving a net decrease in disability. CONCLUSIONS: Decision-making and care planning should integrate the possible trade-offs between early adverse outcomes with longer-term benefit when frailty is present in older surgical patients.
BACKGROUND: Frailty is associated with early postoperative outcomes. How frailty influences long-term postoperative recovery is poorly described. Our objective was to evaluate the association of frailty with postoperative disability trajectories in the year after surgery. METHODS: Prespecified 1-yr follow-up of a prospective multicentre cohort study. Patients ≥65 yr were assessed for frailty before major elective noncardiac surgery (Clinical Frailty Scale [CFS] and Fried Phenotype [FP]). The primary outcome was patient-reported disability score (using the WHO Disability Assessment Schedule 2.0) at baseline, 30, 90, and 365 days after surgery. Repeated measures linear regression estimated the association of preoperative frailty with changes in disability scores over time, adjusted for procedure. Group-based trajectory modelling was used to identify subgroup trajectories of people with frailty. RESULTS: One-year follow-up was complete for 687/702 (97.9%) participants. Frailty was associated with a significant difference in disability trajectory (P<0.0001). Compared with baseline, people with frailty experienced a decrease in disability score at 365 days (CFS frailty: -7.3 points, 95% confidence interval [CI] -10.2 to -4.5); (FP frailty: -5.4 points, 95% CI -8.5 to -2.3); people without frailty had no significant change in their disability score from baseline (no CFS frailty: +0.8 points, 95% CI -1.7 to 3.2; no FP frailty: +1.1 points, 95% CI -3.5 to 1.3). More than one-third of people with frailty experienced an early increase in disability before achieving a net decrease in disability. CONCLUSIONS: Decision-making and care planning should integrate the possible trade-offs between early adverse outcomes with longer-term benefit when frailty is present in older surgical patients.
Authors: Soha Abdellatif; Emily Hladkowicz; Manoj M Lalu; Sylvain Boet; Sylvain Gagne; Daniel I McIsaac Journal: Can J Anaesth Date: 2022-01-31 Impact factor: 6.713
Authors: Duminda N Wijeysundera; Shabbir M H Alibhai; Karim S Ladha; Martine T E Puts; Tyler R Chesney; Julian F Daza; Sahar Ehtesham; Emily Hladkowicz; Gerald Lebovic; C David Mazer; Janet M van Vlymen; Alice C Wei; Daniel I McIsaac Journal: BMJ Open Date: 2022-06-22 Impact factor: 3.006