| Background:As the rate of elderly surgical patients grows faster than the rate of aging,frailty assessment is increasingly applied to surgical patients,and the concept of frailty is becoming more and more familiar to clinicians.Frailty is closely related to the prognosis of patients.There are many different assessment tools have emerged,but no gold standard for frailty assessment had yet been found.Purpose:This is a prospective cohort study to explore the relationshi Pbetween frailty and the prognosis of elderly patients undergoing elective non-cardiac surgery,and to compare the predictive efficacy of different assessment methods,so as to provide a reference for clinicians to make diagnosis and treatment decisions.Methods:We recruited 311 elderly patients who underwent elective non-cardiac surgery under general anesthesia in the Zhongda Hospital Affiliated to Southeast University from February to June 2019.Frailty status was determined prior to surgery.Data on postoperative complication,LOS(length of stay),period from surgery to discharge,hospitalization costs,3-month readmission and 3-month mortality were gathered.Preoperative characteristics in frail versus non-frail patients were compared using t tests or x~2tests.Multiple logistic regression was used to examine the independent association between frailty and the outcomes of interest.We compared area under receiver operator characteristic curves(AUC)for each frailty measure in predicting ICU admission.Results:(1)Frailty prevalence estimates were 33.4%(Fried),19.6%(mFI),and 21.5%(EFT).(2)The three assessment methods all showed differences in the age,type of surgery,and ASA grade of patients with frail and non-frail,that is,frailty rates were higher among older,patients who had orthopedic surgery,and patients with higher ASA grade.In addition,the proportion of female patients with frail was higher than that of male patients(Fried:P<0.001;EFT:P=0.008),and the education level of frail patients was lower than that of non-frail patients(Fried:P=0.001).(3)Frailty associated with higher ICU admission rates(Fried:odds ratio[OR]9.82,95%confidence interval[CI]2.66-36.23,P<0.001;mFI:OR 4.83,95%CI1.84-12.67,P<0.001;EFT:OR 5.32,95%CI 2.00-14.12,P<0.05),higher readmission rate(mFI:P<0.001)and mortality(Fried:OR 3.83,95%CI 1.25-11.73,P<0.05;mFI:OR 3.30,95%CI 1.10-9.90,P<0.05;EFT:OR 5.38,95%CI1.80-16.10,P<0.05)3-month after surgery.But LOS(length of stay),period from postoperative to discharge and hospitalization costs were not significantly associated with frailty.(4)In our sub-analysis about age and ASA grade,we found all the assessment methods were applied to younger elderly and ASAⅡpatients better.(5)The new model we proposed named N had the best predictive ability compare with the other 3 assessments(AUC:Fried:0.859,mFI:0.836,EFT:0.849,N:0.867).Conclusion:Frailty was associated with short-term outcome after non-cardiac surgery.N was a new comprehensive tool with great predictive ability,but need more modification to apply in clinical practice.Future multicenter studies with larger sample sizes are needed to focus on the relationshi Pbetween frailty and long-term outcomes in patients of all ages,and to seek gold criteria for assessing frailty. |
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