The effects of frailty on quality of recovery and complications in older adults undergoing major abdominal surgery: a prospective cohort study

Year 2023, Volume: 6 Issue: 5, 1133 - 1141, 28.09.2023

Hatice Yüceler Kaçmaz Hilal Kahraman Sibel Akın Erdoğan Sözüer

https://doi.org/10.32322/jhsm.1350264

Abstract

Aims: There is an increase in the number of older people who have undergone surgical intervention in proportion to the aging of the global population. This situation creates the need to adapt surgical care according to the pathophysiological profile of older people. Recently, it has been argued that chronological age alone does not explain biological age, and frailty will be an appropriate parameter in organizing surgical care of older people. This study aimed to determine the effect of frailty on 30-day postoperative complications and quality of recovery in older people undergoing major abdominal surgery.
Methods: A prospective cohort study was conducted in the General Surgery Department of the Erciyes University Medical Center in Türkiye. Overall, 222 patients aged 65 and over underwent major abdominal surgery between February 2021 and 2023. Frailty was determined using Fried Frailty Index. 30-day postoperative complications were evaluated using the Clavien Dindo Classification. Quality of recovery- 40 (QoR-40) was filled three days after surgery to determine the quality of recovery of the patients. Receiver-operating characteristic curves analysis was used to evaluate the ability to predict 30-day complications of frailty. Univariate linear regression analysis was performed to determine frailty to be an independent predictor of the QoR-40.
Results: The majority of the participants were male (56.8%), the mean age was 71.41±5.29 years, and 50% of patients were frail. Frail patients (28.1%) showed a higher rate of major complications compared to non-frail patients (9.3%). The Fried frailty index score significantly predicted 30-day postoperative complications (AUC=0.653, 95%=0.565-0.741). The total mean score of the QoR-40 scale was 147.09±15.82. Univariate linear regression analysis found frailty (OR -3.81, 95% CI -4.79- -2,83), age (OR -0,46, 95% CI -0,79- -0,12), Charlson comorbidity index (OR -2,40, 95% CI -3,23- -1,57), and operation time (OR -0,04, 95% CI -0,06- -0,02) as independent predictors of quality of recovery.
Conclusion: Frailty is a significant predictor for 30-day postoperative complications and quality of recovery in older people undergoing major abdominal surgery.

Keywords

Frailty, abdominal surgery, quality of recovery, postoperative complication, older people

References

• Rafalimanana H. World Population Ageing. Economic and Social Affairs United Nations. 2020. 1-47 p. Available from: http://link.springer.com/chapter/10.1007/978-94-007-5204-7_6
• Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal Perioperative Management of the Geriatric Patient: Best Practices Guideline from ACS NSQIP® /American Geriatrics Society. J Am Coll Surg. 2016;222:930-4(5):930-934.
• Ayan FS, Dagtekin T. Geriatrik cerrahide güncel yaklaşımlar. İstanbul Gelişim Üniversitesi Sağlık Bilim Derg. 2020;12(12):460-74.
• Office for National Statistics. Estimates of the Very Old (including Centenarians): England and Wales, and United Kingdom, 2002 to 2014. 2015. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/bulletins/estimatesoftheveryoldincludingcentenarians/previousReleases
• Partridge JSL, Moonesinghe SR, Lees N, Dhesi JK. Perioperative care for older people. Age Ageing. 2022;51(8):1-6.
• Simões CM, Carmona MJC, Hajjar LA, et al. Predictors of major complications after elective abdominal surgery in cancer patients. BMC Anesthesiol. 2018;18(1):1-8.
• Kassahun WT, Babel J, Mehdorn M. Assessing differences in surgical outcomes following emergency abdominal exploration for complications of elective surgery and high-risk primary emergencies. Sci Rep. 2022;12(1):1-10. doi:10.1038/s41598-022-05326-4
• British Geriatrics Society. Guideline for the care of people living with frailty undergoing elective and emergency surgery that encompasses the whole perioperative pathway. 2021. Available from: https://www.bgs.org.uk/cpocfrailty
• Pang CL, Gooneratne M, Partridge JSL. Preoperative assessment of the older patient. BJA Educ. 2021;21(8):314-20. doi:10.1016/j.bjae.2021.03.005
• Sandini M, Pinotti E, Persico I, Picone D, Bellelli G, Gianotti L. Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery. BJS Open. 2017;1(5):128-137.
• Chen Y, Wang J, Liu S, Lai W, Liu J, Wang Z, et al. Development and validation of the Chinese version of the quality of recovery-40 questionnaire. Ther Clin Risk Manag. 2020;16:1165-73.
• Gornall BF, Myles PS, Smith CL, et al. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth. 2013;111(2):161-169.
• Christner S, Ritt M, Volkert D, Wirth R, Sieber CC, Gaßmann KG. Evaluation of the nutritional status of older hospitalised geriatric patients: a comparative analysis of a Mini Nutritional Assessment (MNA) version and the Nutritional Risk Screening (NRS 2002). J Hum Nutr Diet. 2016;29(6):704-713.
• Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383.
• Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):146-156.
• Manekk RS, Gharde P, Gattani R, Lamture Y. Surgical complications and its grading: a literature review. Cureus. 2022;14(5).
• Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213.
• Myles P, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: The QoR-40. Br J Anaesth. 2000;84(1):11-15.
• Karaman S, Arici S, Dogru S, et al. Validation of the Turkish version of the quality of recovery-40 questionnaire. Health Qual Life Outcomes. 2014;12(1):1-6.
• Yin Y, Jiang L, Xue L. Comparison of three frailty measures for 90-day outcomes of elderly patients undergoing elective abdominal surgery. ANZ J Surg. 2021;91(3):335-340.
• Aguilar-Frasco JL, Rodríguez-Quintero JH, Moctezuma-Velázquez P, et al. Frailty index as a predictive preoperative tool in the elder population undergoing major abdominal surgery: a prospective analysis of clinical utility. Langenbeck’s Arch Surg. 2021;406(4):1189-1198.
• Than TNH, Nguyen T, Nguyen TTT, Pham T. Frailty and adverse outcomes among older patients undergoing gastroenterological surgery in vietnam. J Multidiscip Healthc. 2021;14:2695-703.
• Kennedy CA, Shipway D, Barry K. Frailty and emergency abdominal surgery: a systematic review and meta-analysis. Surgeon. 2022;20(6):e307-14. doi:10.1016/j.surge.2021.11.009
• Han B, Li Q, Chen X. Effects of the frailty phenotype on post-operative complications in older surgical patients: a systematic review and meta-analysis. BMC Geriatr. 2019;19(1):1-9.
• Aceto P, Perilli V, Luca E, et al. Predictive power of modified frailty index score for pulmonary complications after major abdominal surgery in the elderly: a single centre prospective cohort study. Eur Rev Med Pharmacol Sci. 2021;25(10):3798-3802.
• Tan HL, Chia STX, Nadkarni NV, Ang SY, Seow DCC, Wong TH. Frailty and functional decline after emergency abdominal surgery in the elderly: A prospective cohort study. World J Emerg Surg. 2019;14(1):1-7.
• Li JL, Henderson MA, Revenig LM, et al. Frailty and one-year mortality in major intra-abdominal operations This study was presented at the World Congress of Endourology in London in October 2015. J Surg Res. 2016;203(2):507-512. doi:10.1016/j.jss.2016.03.007
• Parmar KL, Pearce L, Farrell I, Hewitt J, Moug S. Influence of frailty in older patients undergoing emergency laparotomy: a UK-based observational study. BMJ Open. 2017;7(10):1-5.
• Oreskov JO, Burcharth J, Nielsen AF, Ekeloef S, Kleif J, Gögenur I. Quality of recovery after major emergency abdominal surgery: a prospective observational cohort study. Minerva Chir. 2020;75(2):104-110.
• Günel B, Özşaker E. Investigation of the relationship between the level of vulnerability and recovery quality of elderly patients hospitalized in the neurosurgery clinic. Ege üniversitesi; 2021.
• Wessels E, Perrie H, Scribante J, Jooma Z. Quality of recovery following orthopedic surgery in patients at an academic hospital in South Africa. Anesth Analg. 2021;133(2):507-514.
• Chazapis M, Walker EMK, Rooms MA, Kamming D, Moonesinghe SR. Measuring quality of recovery-15 after day case surgery. Br J Anaesth. 2016;116(2):241-248.
• Marinho R, Lusquinhos J, Carvalho B, Azevedo J, Santos A, Abelha F. Quality of recovery after surgery for cancer treatment. Rev Española Anestesiol y Reanim. 2018;65(8):426-433. doi:10.1016/j.redare.2018.04.012
• Ferraz SM, Moreira JP, Mendes LC, et al. Evaluation of the quality of recovery and the postoperative health status after elective surgery. Brazilian J Anesthesiol. 2018;68(6):577-583.
• Guimarães-Pereira L, Costa M, Sousa G, Abelha F. Quality of recovery after anaesthesia measured with QoR-40: a prospective observational study. Brazilian J Anesthesiol. 2016;66(4):369-375.
• Marinho R, Lusquinhos J, Carvalho B, Azevedo J, Santos A, Abelha F. Quality of recovery after surgery for cancer treatment. Rev Española Anestesiol y Reanim. 2018;65(8):426-433.
• Liu C, Gao W, Zhou L, et al. Can the Tilburg Frailty Indicator predict post-operative quality of recovery in patients with gynecologic cancer? a prospective cohort study. Int J Gynecol Cancer. 2023;33(5):1-6.