Provider miscategorization of frailty in an outpatient urogynecologic population

Abstract

Introduction and hypothesis

Routine assessment of frailty preoperatively is recommended for older adults, because frailty is associated with adverse surgical outcomes. This study was aimed at describing the percentage of patients whose frailty status was correctly categorized by Female Pelvic Medicine and Reconstructive Surgery (FPRMS) providers and to determine patient predictors of accurate categorization.

Methods

Cross-sectional study was carried out of English speaking, new patients, >65 years old, presenting from March to June 2018. Providers categorized patients as frail, pre-frail, or not frail based on clinical impression. Frailty was defined using the Fried Frailty Assessment (FFA), a validated, objective measure including weight loss, exhaustion, physical activity, walk speed, and grip strength. Provider categorizations were compared with FFA results. Multiple logistic regression was used to estimate patient predictors of frailty categorization. Data from other fields that approximated a 45% proportion of miscategorization guided sample size estimates.

Results

Ten FPMRS providers participated, and 106 out of 110 patients (96%) had complete data. Primary diagnoses were pelvic organ prolapse (37%), incontinence (20%), and overactive bladder (17%). On FFA, 16 (15%) patients were frail, 50 (47%) were pre-frail, and 40 (38%) were not frail. The overall proportion of miscategorization was 58% (95% confidence interval 49–68%). Providers correctly categorized 50% of frail patients, 34% of pre-frail patients, and 48% of non-frail patients. Slow walk time was associated with provider categorization of frailty, regardless of frailty status (p = 0.01).

Conclusions

Clinical impression may not adequately assess frailty. Miscategorization of frailty by FPMRS providers was higher than in other fields.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    CAS  Article  Google Scholar 

  2. 2.

    Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210:901e8.

    Article  Google Scholar 

  3. 3.

    Revenig LM, Canter DJ, Taylor MD, Tai C, Sweeney JF, Sarmiento JM, et al. Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes. J Am Coll Surg. 2013;217(4):665–670.e1.

    Article  Google Scholar 

  4. 4.

    Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2009;48(1):78–83.

    Article  Google Scholar 

  5. 5.

    Suskind AM, Jin C, Cooperberg MR, Finlayson E, Boscardin WJ, Sen S, et al. Preoperative frailty is associated with discharge to skilled or assisted living facilities after urologic procedures of varying complexity. Urology. 2016;97:25–32.

    Article  Google Scholar 

  6. 6.

    Hewitt J, Moug SJ, Middleton M, Chakrabarti M, Stechman MJ, McCarthy K. Older persons surgical outcomes collaboration. Prevalence of frailty and its association with mortality in general surgery. Am J Surg. 2015;209(2):254–9.

    Article  Google Scholar 

  7. 7.

    Optimal perioperative management of the geriatric patient: best practices guideline from ACS/NSQIP/American Geriatrics Society. https://www.facs.org/~/media/files/quality%20programs/geriatric/acs%20nsqip%20geriatric%202016%20guidelines.

  8. 8.

    Erekson EA, Yip SO, Ciarleglio MM, Fried TR. Postoperative complications after gynecologic surgery. Obstet Gynecol. 2011;118(4):785–93.

    Article  Google Scholar 

  9. 9.

    Suskind AM, Quanstrom K, Zhao S, et al. Overactive bladder is strongly associated with frailty in older individuals. Urology. 2017;106:26–31.

    Article  Google Scholar 

  10. 10.

    Adedayo P, Resnick K, Singh S. Preoperative frailty is a risk factor for non-home discharge in patients undergoing surgery for endometrial cancer. J Geriatr Oncol. 2018;9:513–5.

    Article  Google Scholar 

  11. 11.

    Courtney-Brooks M, Tellawi AR, Scalici J, Duska LR, Jazaeri AA, Modesitt SC, et al. Frailty: an outcome predictor for elderly gynecologic oncology patients. Gynecol Oncol. 2012;126(1):20–4.

    Article  Google Scholar 

  12. 12.

    Uppal S, Igwe E, Rice LW, Spencer RJ, Rose SL. Frailty index predicts severe complications in gynecologic oncology patients. Gynecol Oncol. 2015;137(1):98–101.

    Article  Google Scholar 

  13. 13.

    Erekson EA, Fried TR, Bynum JPW. Frailty, cognitive impairment, and functional disability in older women with female pelvic floor dysfunction. Int Urogynecol J. 2015;26(5):823–39.

    Article  Google Scholar 

  14. 14.

    Zeno A, Alvarez P, Yazdany T. A systematic review of frailty assessments in women with pelvic floor disorders: are we following the American College of Surgeons National Surgical Quality Improvement Program/American Geriatric Society guidelines? Female Pelvic Med Reconstr Surg. 2018;24(2):135–41.

    Article  Google Scholar 

  15. 15.

    Suskind AM, Jin C, Walter LC. Frailty and the role of obliterative versus reconstructive surgery for pelvic organ prolapse: a national study. J Urol. 2017;197(6):1502–6.

    Article  Google Scholar 

  16. 16.

    Hope AA, Hsieh SJ, Petti A, Hurtado-Sbordoni M, Verghese J, Gong MN. Assessing the usefulness and validity of frailty markers in critically ill adults. Ann Am Thorac Soc. 2017;14(6):952–9. https://doi.org/10.1513/AnnalsATS.201607-538OC.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Salter ML, Gupta N, Massie AB, McAdams-DeMarco MA, Law AH, Jacob RL, et al. Perceived frailty and measured frailty among adults undergoing hemodialysis: a cross-sectional analysis. BMC Geriatr. 2015;15:52.

    Article  Google Scholar 

  18. 18.

    Avila-Funes JA, Medina-Campos RH, Tamez-Rivera O, Navarrete-Reyes AP, Amieva H, Aguilar-Navarro S. Frailty is associated with disability and recent hospitalization in community-dwelling elderly: the Coyoacan cohort. J Frailty Aging. 2014;3(4):206–10.

    CAS  PubMed  Google Scholar 

  19. 19.

    Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62(7):738–43.

    Article  Google Scholar 

  20. 20.

    Orme J, Reis J, Herz E. Factorial and discriminate validity of the Center for Epidemiological Studies Depression (CES-D) scale. J Clin Psychol. 1986;42:28–33.

    CAS  Article  Google Scholar 

  21. 21.

    Taylor HL, Jacobs DR, Schuker B, Knudsen J, Leon AS, Debacker G. A questionnaire for the assessment of leisure-time physical activities. J Chronic Dis. 1978;31:745–55.

    Article  Google Scholar 

  22. 22.

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  Google Scholar 

  23. 23.

    Boysen WR, Adamsky MA, Cohen AJ, Rodriguez J, Faris SF, Bales GT. Thirty-day morbidity of abdominal sacrocolpopexy is influenced by additional surgical treatment for stress urinary incontinence. Urology. 2017;109:82–7.

    Article  Google Scholar 

  24. 24.

    Johnson TM 2nd, Kincade JE, Bernard SL, Busby-Whitehead J, Hertz-Picciotto I, DeFriese GH. The association of urinary incontinence with poor self-rated health. J Am Geriatr Soc. 1998;46(6):693–9.

    Article  Google Scholar 

  25. 25.

    Berardelli M, de Rango F, Morelli M, Corsonello A, Mazzei B, Mari V, et al. Urinary incontinence in the elderly and in the oldest old: correlation with frailty and mortality. Rejuvenation Res. 2013;16(3):206–11.

    Article  Google Scholar 

  26. 26.

    Ferguson MK, Thompson K, Huisingh-Scheetz M, Farnan J, Hemmerich J, Acevedo J, et al. The impact of a frailty education module on surgical resident estimates of lobectomy risk. Ann Thorac Surg. 2015;100(1):235–41.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Julia K. Shinnick.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Shinnick, J.K., Raker, C.A. & Sung, V. Provider miscategorization of frailty in an outpatient urogynecologic population. Int Urogynecol J 31, 1529–1535 (2020). https://doi.org/10.1007/s00192-019-04095-5

Download citation

Keywords

  • Frailty
  • Frailty assessment
  • Frailty and pelvic floor disorders