Seniors, Surgery, And The Frailty Index
The Frailty Index: How It Helps Determine Eligibility and Outcome of Surgery
America’s aging Baby Boomer population has led to an increase in the number of seniors who need surgical procedures. Studies and experience have shown that the level of frailty in a senior can help predict the outcome of surgery. As a way to gauge how senior patients will respond to a procedure, doctors use a measure called the Frailty Index (FI). FI is a commonly used predictor of morbidity and mortality in patients older than 60 years undergoing an emergency or general surgical procedure.
Traditionally, a person’s eligibility for surgery has been based largely upon biological age. In recent years, however, a person’s level of frailty (under-stood as a general decline in functional status) has come to be recognized as an independent risk factor for adverse health outcomes. That is, old age by itself does not define frailty. Some patients, despite advanced age, may experience temporary disability related to illness or trauma, but they rebound after recovery and return to their regular health. Others may appear robust but tolerate medical stress poorly, and never regain full function following illness or hospitalization. Still others are noted to have gradual but unrelenting functional decline in the absence of apparent stress factors.
Frail older adults represent a challenge to clinicians because they often have an increased burden of symptoms that are often medically complex and are less able to tolerate interventions of any kind. Clinician awareness of the frailty syndrome, its biologic basis, and the increased risk for adverse outcomes can improve care for this most vulnerable subset of patients.
A number of different indices exist for measuring age-related frailty, but generally frailty is measured by constructing an FI based on the accumulation of a variety of functional deficits (such as comorbid illness, poor health attitudes, signs of disease, and self-reported disabilities). Recently, a more simplified frailty index was created by surgeons at Wayne State University School of Medicine in Detroit, Mich., to function as a reliable tool for assessing risk of mortality and serious complications in older patients considering total hip and knee replacement procedures.
“We felt that age and general impression of the patient wasn’t adequate for predicting outcomes, so we created a simplified frailty index to stratify risk of mortality and morbidity in surgical patients,” said study coauthor Peter Adams, MD, a resident in general surgery at Henry Ford Hospital, Detroit, Mich. “We started our analysis in elderly emergent patients, and then moved on to vascular patients, and with this research, we have narrowed it down to two specific procedures.”
Their simplified frailty index takes into account 11 data points collected by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) database. Since most of these variables are considered co-morbidities, such as history of heart attack, stent and hypertension, health care providers can easily calculate a patient’s frailty score by taking a simple medical history.
“I think using our frailty index can kind of enlighten surgeons into recognizing that even if they are doing an elective case, such as total knee or hip replacement, sicker patients who have significant medical histories may have a high risk of wound infections and even mortality,” Dr. Adams said. “This frailty score will allow surgeons to have accurate and meaningful conversations with patients about their risk.”
Importantly, Dr. Adams points out that this frailty score could also be used to show that elderly patients should not be denied an option for surgical treatment. Patients who have low frailty scores will probably do well and should be considered on the merits of their health, and not solely on age.
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BLOG Date: Tuesday, February 3, 2015
Writer: Ryan Allen