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World Journal of Surgery

, Volume 43, Issue 2, pp 415–424 | Cite as

Postoperative Recovery in Frail, Pre-frail, and Non-frail Elderly Patients Following Abdominal Surgery

  • Tarifin Sikder
  • Nadia Sourial
  • Geva Maimon
  • Mehdi Tahiri
  • Debby Teasdale
  • Howard Bergman
  • Shannon A. Fraser
  • Sebastian Demyttenaere
  • Simon BergmanEmail author
Original Scientific Report
  • 229 Downloads

Abstract

Background

The objective of this study is to explore the association between frailty and surgical recovery over a 6-month period, in elderly patients undergoing elective abdominal surgery.

Methods

A total of 144 patients were categorized as frail, pre-frail, and non-frail based on five criteria: weight loss, exhaustion, weakness, slowness, and low activity. Recovery to preoperative functional status (activities of daily living (ADL) and instrumental activities of daily living (IADL)), cognition, quality of life, and mental health was assessed at 1, 3, and 6 months postoperatively. A repeated measure logistic regression was used to analyze the effect of frailty on recovery over time. The effect of frailty on hospitalization outcomes was also evaluated.

Results

Mean age was 78 ± 5 years with 17.4% of patients categorized as frail, 60.4% pre-frail, and 22.2% non-frail. At 6 months, the percent of patients who had recovered to preoperative values were: ADL 90%; IADL 76%; cognition 75.5%; mental health 66%; and quality of life 70%. While more frail patients experienced adverse hospitalization outcomes and fewer had recovered to preoperative functional status, these differences were not found to be statistically significant. Overall, frailty status was not significantly associated with the trajectory of recovery or hospitalization outcomes.

Conclusion

Strong, institutional commitment to quality surgical care, as well as appropriate strategies for older patients, may have mitigated the impact of frailty on recovery. Further research is needed to examine the role of frailty in the surgical recovery process.

Notes

Funding

This project was supported by the Canadian Institute of Health Research and St. Mary’s Hospital Center.

Compliance with ethical standards

Conflict of interest

Ms. Sikder, Dr. Maimon, Ms. Sourial, Dr. Tahiri, Ms. Teasdale, Dr. H. Bergman, Dr. S. Bergman, and Dr. Demyttenaere have no conflicts of interest or financial relationships to disclose. Dr. Fraser is a preceptor for Covidien and Bard Canada.

References

  1. 1.
    Etzioni DA, Liu JH, Maggard MA, Ko CY (2003) The aging population and its impact on the surgery workforce. Ann Surg 238(2):170Google Scholar
  2. 2.
    Ronning B, Wyller TB, Jordhoy MS, Nesbakken A, Bakka A, Seljeflot I et al (2014) Frailty indicators and functional status in older patients after colorectal cancer surgery. J Geriatr Oncol 5(1):26–32CrossRefGoogle Scholar
  3. 3.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Geront Ser A Biol Sci Med Sci 56(3):M146–M156CrossRefGoogle Scholar
  4. 4.
    Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P et al (2010) Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210(6):901–908CrossRefGoogle Scholar
  5. 5.
    Chimukangara M, Frelich MJ, Bosler ME, Rein LE, Szabo A, Gould JC (2016) The impact of frailty on outcomes of paraesophageal hernia repair. J Surg Res 202(2):259–266CrossRefGoogle Scholar
  6. 6.
    Cooper Z, Rogers SO Jr, Ngo L, Guess J, Schmitt E, Jones RN, et al (2016) Comparison of frailty measures as predictors of outcomes after orthopedic surgery. J Am Geriatr Soc 64(12):2464–2471CrossRefGoogle Scholar
  7. 7.
    Dunne MJ, Abah U, Scarci M (2014) Frailty assessment in thoracic surgery. Interact CardioVasc Thorac Surg 18(5):667–670CrossRefGoogle Scholar
  8. 8.
    Farhat JS, Velanovich V, Falvo AJ, Horst HM, Swartz A, Patton JH Jr et al (2012) Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg 72(6):1526–1531CrossRefGoogle Scholar
  9. 9.
    McAdams-DeMarco MA, King EA, Luo X, Haugen C, DiBrito S, Shaffer A, et al (2017) Frailty, length of stay, and mortality in kidney transplant recipients: A National Registry and Prospective Cohort Study. Ann Surg 266(6):1084–1090CrossRefGoogle Scholar
  10. 10.
    Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland JC Jr, Moss M (2013) Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 206(4):544–550CrossRefGoogle Scholar
  11. 11.
    Curtis JR (1998) The “patient-centered” outcomes of critical care: what are they and how should they be used? New Horizons (Baltimore, Md) 6(1):26–32Google Scholar
  12. 12.
    Snyder CF, Jensen RE, Segal JB, Wu AW (2013) Patient-reported outcomes (PROs): putting the patient perspective in patient-centered outcomes research. Med Care 51(8 Suppl 3):S73–S79CrossRefGoogle Scholar
  13. 13.
    Afilalo J, Eisenberg MJ, Mottillo S, Boivin JF, Morin JF, Langlois Y et al (2012) Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes Circ: Cardiovasc Qual Outcomes 5(2):222–228CrossRefGoogle Scholar
  14. 14.
    Afilalo J, Karunananthan S, Eisenberg MJ, Alexander KP, Bergman H (2009) Role of frailty in patients with cardiovascular disease. Am J Cardiol 103(11):1616–1621CrossRefGoogle Scholar
  15. 15.
    Bagnall NM, Faiz O, Darzi A, Athanasiou T (2013) What is the utility of preoperative frailty assessment for risk stratification in cardiac surgery? Interact CardioVasc Thorac Surg 17(2):398–402CrossRefGoogle Scholar
  16. 16.
    Rajabali N, Rolfson D, Bagshaw SM (2016) Assessment and utility of frailty measures in critical illness, cardiology, and cardiac surgery. Can J Cardiol 32(9):1157–1165CrossRefGoogle Scholar
  17. 17.
    Karam J (2013) Simplified frailty index to predict adverse outcomes and mortality in vascular surgery patients. Ann Vasc Surg 27(7):904CrossRefGoogle Scholar
  18. 18.
    Chen FF, Zhang FY, Zhou XY, Shen X, Yu Z, Zhuang CL (2016) Role of frailty and nutritional status in predicting complications following total gastrectomy with D2 lymphadenectomy in patients with gastric cancer: a prospective study. Langenbeck’s Arch Surg 401(6):813–822CrossRefGoogle Scholar
  19. 19.
    Robinson TN, Wallace JI, Wu DS, Wiktor A, Pointer LF, Pfister SM et al (2011) Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg 213(1):37–42; discussion-4 CrossRefGoogle Scholar
  20. 20.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefGoogle Scholar
  21. 21.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefGoogle Scholar
  22. 22.
    Puts MT, Monette J, Girre V, Costa-Lima B, Wolfson C, Batist G et al (2010) Potential medication problems in older newly diagnosed cancer patients in Canada during cancer treatment. Drugs Aging 27(7):559–572CrossRefGoogle Scholar
  23. 23.
    Sourial N, Bergman H, Karunananthan S, Wolfson C, Guralnik J, Payette H et al (2012) Contribution of frailty markers in explaining differences among individuals in five samples of older persons. J Gerontol Ser A: Biol Sci Med Sci 67(11):1197–1204CrossRefGoogle Scholar
  24. 24.
    Bandeen-Roche K, Xue QL, Ferrucci L, Walston J, Guralnik JM, Chaves P et al (2006) Phenotype of frailty: characterization in the women’s health and aging studies. J Gerontol Ser A Biol Sci Med Sci 61(3):262–266CrossRefGoogle Scholar
  25. 25.
    Kasper J, Lafferty M (1995) The Women’s Health and Aging Study: health and social characteristics of older women with disability. National Institute on Aging, BethesdaGoogle Scholar
  26. 26.
    Sikder T, Maimon G, Sourial N, Tahiri M, Teasdale D, Bernier P et al (2018) Assessing the effect of preoperative nutrition on upper body function in elderly patients undergoing elective abdominal surgery. J Parent Enter Nutr 42(3):566–572Google Scholar
  27. 27.
    Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E et al (2003) Physical performance measures in the clinical setting. J Am Geriatr Soc 51(3):314–322CrossRefGoogle Scholar
  28. 28.
    Brinson ZS, Tang VL, Finlayson E (2016) Postoperative functional outcomes in older adults. Curr Surg Rep 4(6):1–6CrossRefGoogle Scholar
  29. 29.
    Puts MT, Monette J, Girre V, Pepe C, Monette M, Assouline S et al (2011) Are frailty markers useful for predicting treatment toxicity and mortality in older newly diagnosed cancer patients? Results from a prospective pilot study. Crit Rev Oncol/Hematol 78(2):138–149CrossRefGoogle Scholar
  30. 30.
    Daley J, Khuri SF, Henderson W, Hur K, Gibbs JO, Barbour G et al (1997) Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs surgical risk study1. J Am Coll Surg 185(4):328–340Google Scholar
  31. 31.
    Khuri SF, Daley J, Henderson WG (2002) The comparative assessment and improvement of quality of surgical care in the department of veterans affairs. Arch Surg 137(1):20–27CrossRefGoogle Scholar
  32. 32.
    Slankamenac K, Nederlof N, Pessaux P, de Jonge J, Wijnhoven BP, Breitenstein S et al (2014) The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg 260(5):757–762CrossRefGoogle Scholar
  33. 33.
    Katz S (1983) Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31(12):721–727CrossRefGoogle Scholar
  34. 34.
    Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36(4):428–434CrossRefGoogle Scholar
  35. 35.
    Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I et al (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699CrossRefGoogle Scholar
  36. 36.
    Almeida OP, Almeida SA (1999) Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 14(10):858–865CrossRefGoogle Scholar
  37. 37.
    Group TE (1990) EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208CrossRefGoogle Scholar
  38. 38.
    Shaw JW, Johnson JA, Coons SJ (2005) US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care 43(3):203–220CrossRefGoogle Scholar
  39. 39.
    Chen CC, Chen CN, Lai IR, Huang GH, Saczynski JS, Inouye SK (2014) Effects of a modified Hospital Elder Life Program on frailty in individuals undergoing major elective abdominal surgery. J Am Geriatr Soc 62(2):261–268CrossRefGoogle Scholar
  40. 40.
    Li JL, Henderson MA, Revenig LM, Sweeney JF, Kooby DA, Maithel SK et al (2016) Frailty and one-year mortality in major intra-abdominal operations. YJSRE J Surg Res 203(2):507-12.e1Google Scholar
  41. 41.
    Ronning B, Wyller TB, Nesbakken A, Skovlund E, Jordhoy MS, Bakka A et al (2016) Quality of life in older and frail patients after surgery for colorectal cancer-a follow-up study. J Geriatr Oncol 7(3):195–200CrossRefGoogle Scholar
  42. 42.
    Amemiya T, Oda K, Ando M, Kawamura T, Kitagawa Y, Okawa Y et al (2007) Activities of daily living and quality of life of elderly patients after elective surgery for gastric and colorectal cancers. Ann Surg 246(2):222–228CrossRefGoogle Scholar
  43. 43.
    Finlayson E, Zhao S, Boscardin WJ, Fries BE, Landefeld CS, Dudley RA (2012) Functional status after colon cancer surgery in elderly nursing home residents. J Am Geriatr Soc 60(5):967–973CrossRefGoogle Scholar
  44. 44.
    Lawrence VA, Hazuda HP, Cornell JE, Pederson T, Bradshaw PT, Mulrow CD et al (2004) Functional independence after major abdominal surgery in the elderly. J Am Coll Surg 199(5):762–772CrossRefGoogle Scholar
  45. 45.
    Aahlin EK, Trano G, Johns N, Horn A, Soreide JA, Fearon KC et al (2017) Health-related quality of life, cachexia and overall survival after major upper abdominal surgery: a prospective cohort study. Scand J Surg 106(1):40–46CrossRefGoogle Scholar
  46. 46.
    Zalon ML (2004) Correlates of recovery among older adults after major abdominal surgery. Nurs Res 53(2):99–106CrossRefGoogle Scholar
  47. 47.
    Hewitt J, Moug SJ, Middleton M, Chakrabarti M, Stechman MJ, McCarthy K (2015) Prevalence of frailty and its association with mortality in general surgery. Am J Surg 209(2):254–259CrossRefGoogle Scholar
  48. 48.
    Kristjansson SR, Nesbakken A, Jordhoy MS, Skovlund E, Audisio RA, Johannessen HO et al (2010) Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol/Hematol 76(3):208–217CrossRefGoogle Scholar
  49. 49.
    Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M (2009) Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr 48(1):78–83CrossRefGoogle Scholar
  50. 50.
    Avila-Funes JA, Pina-Escudero SD, Aguilar-Navarro S, Gutierrez-Robledo LM, Ruiz-Arregui L, Amieva H (2011) Cognitive impairment and low physical activity are the components of frailty more strongly associated with disability. J Nutr Health aging. 15(8):683–689CrossRefGoogle Scholar
  51. 51.
    Leung JM, Tsai TL, Sands LP (2011) Preoperative frailty in older surgical patients is associated with early postoperative delirium. Anesth Analg 112(5):1199–1201CrossRefGoogle Scholar
  52. 52.
    Chia CLK, Mantoo SK, Tan KY (2016) ‘Start to finish trans-institutional transdisciplinary care’: a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Dis 18(1):O43–O50CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Tarifin Sikder
    • 1
    • 2
  • Nadia Sourial
    • 1
  • Geva Maimon
    • 1
  • Mehdi Tahiri
    • 2
    • 3
  • Debby Teasdale
    • 1
  • Howard Bergman
    • 1
    • 4
  • Shannon A. Fraser
    • 3
  • Sebastian Demyttenaere
    • 2
  • Simon Bergman
    • 1
    • 3
    Email author
  1. 1.Lady Davis Institute for Medical ResearchMontrealCanada
  2. 2.St-Mary’s Hospital CenterMcGill UniversityMontrealCanada
  3. 3.Division of General Surgery, Department of Surgery, Jewish General HospitalMcGill UniversityMontrealCanada
  4. 4.Department of Family MedicineMcGill UniversityMontrealCanada

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