One-minute frailty test may improve surgical outcomes

One minute of a physician’s time could help determine how likely a urologic patient is to experience complications after an operation, say researchers from Emory University School of Medicine, Atlanta.

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The study, which was published online ahead of print in the Journal of the American College of Surgeons (Feb. 24, 2015), included data from 351 patients age 18 years or older who had been admitted to Emory for major urologic, abdominal, or gastrointestinal operations.

The standard test to measure frailty, described by Linda P. Fried, MD, MPH, and colleagues at Johns Hopkins University, Baltimore (J Gerontol A Biol Sci Med Sci 2001; 56:M146–56), includes five criteria:

• shrinking (self-reported unintentional weight loss of more than 10 pounds in the last year)

• grip strength (measured by having the patient squeeze a hand-held dynamometer adjusted for gender and body mass index)

• exhaustion (measured by responses to questions about effort and motivation)

• low activity (ascertained by inquiring about leisure activities)

• slowed walking speed (measured by the speed at which a patient walks 15 feet adjusted by gender and height).

Despite the importance of measuring patient frailty, many surgical practices may skip performing this five-step assessment, according to a press release from the American College of Surgeons.

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Therefore, the Emory study authors set out to find a simpler, quicker, more accurate way to assess frailty. After completing the full five-step frailty assessment on the 351 patients in the study, they looked at medical records and found that 36.7% had experienced a complication within 30 days after an operation. Examples of complications included wound infection, pneumonia, stroke, and death.

Next: Truncated assessment evaluated

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The authors next compared the full frailty test’s ability to predict these complications to a more truncated version that only assessed grip strength and involuntary weight loss. They found that assessing just those two factors was equally as accurate at predicting complications as doing the full five-step test.

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They also found that adding two factors-American Society of Anesthesiology score and hemoglobin levels-improved the model’s ability to predict postoperative complications.

The full five-step test normally requires a trained clinician to collect the data, and could take about 10 minutes.

“This method-asking one question about weight loss and the grip strength activity-can take less than a minute and can be done by anyone who interacts with the patient,” said co-author Viraj Master, MD, PhD.

Moving forward, the authors’ goal is to increase surgical teams’ willingness to perform the frailty test on each patient before an operation, not to reject patients for a procedure but rather as a planning measure.

“This step is important for setting expectations for the patient and the family,” said co-author Kenneth Ogan, MD. “If a patient is found to be frail prior to surgery, it is critical that the patient is aware that their risk of a postoperative complication is increased. Our data is clear: If you have a weak grip and you’re losing weight, you’re at risk. We want to be better prepared for any risks after the operation.”

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