Impact of frailty on surgical outcomes: The right patient for the right procedure

Background. Measuring frailty may improve patient selection for high-risk procedures. Methods. Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent elective high-risk operative procedures, and a frailty index was used to classify the patients. Results. Our study analyzed 232,352 patients with a mean age of 65 years; the majority of patients were males (54%) and white (78%). The most common procedure was colectomy (41 %), followed by lower extremity bypass (25 %), gastrectomy (8%), endovascular abdominal aneurism repair (7%), pancreatectomy (7%), cardiac operation (6%), nephrectomy (3 %), and pulmonary resection (2%). A majority of the patients were classified as mildly frail (34%), followed by nonfrail (29%), moderately frail (21 %), and severely frail (15 %). On univariate analysis, age, race, procedure, sex, and frailty scores were associated with complications, prolonged duration of stay, and 30-day mortality (P < .0001). On multivariate analysis, frailty was associated with complications, prolonged duration of stay, and 30 day mortality. Increasing frailty disproportionately impacted mortality; colectomy showed the greatest mortality in severely frail patients (9.36%), followed by esophagectomy (8.2%), pulmonary resection (6.4%), pancreatectomy (5.8%), cardiac procedures (4.4%), gastrectomy (4.3 %), nephrectomy (3.32%), endovascular abdominal aneurism repair (2.49%), and lower extremity bypass (2.41 %; P = .0001). A similar association between duration of stay and morbidity with frailty was noted. Conclusion. Frailty has a significant impact on postoperative outcomes that varies with type of procedure.