A brief, more efficient test has been discovered that could better determine a patient’s frailty prior to surgery, according to research recently published in the Journal of the American College of Surgeons.
The discovery by surgeons at Emory School of Medicine in Atlanta was published Feb. 25 and highlights the importance of evaluating frailty before surgery. Experts say measuring frailty is crucial because patients who are frail, no matter their age, are more prone to postoperative issues.
According to an American College of Surgeons news release, five criteria exist to evaluate frailty before surgery as described by geriatrician Linda P. Fried and colleagues at Johns Hopkins University, Balitmore, Md. They include shrinking or self-reported unintentional weight loss of more than 10 pounds in the last year; grip strength, which is measured by having the patient squeeze a hand-held dynamometer adjusted for gender and body mass index; and exhaustion, measured by responses to questions about effort and motivation. Other criteria include low activity, which is ascertained by inquiring about leisure time activities, and slowed walking speed, measured by the speed at which a patient walks 15 feet and adjusted by gender and height.
When researchers began their study, they first used the standard frailty test, evaluating 351 patients ages 18 or older who were admitted to Emory for major abdominal, urologic or gastrointestinal surgeries, the news release said. When looking at medical records, they found that 36.7% had experienced a complication within 30 days after an operation. Of those complications, 24.5% were minor and 14% were major. Among the issues patients experienced were wound infection, pneumonia, stroke and death.
Researchers found that using just two of the criteria for frailty testing — grip strength and involuntary weight loss were just as accurate as using all five criteria, the news release stated. Surgical practices often skip the five-step assessment, the release said, because it is too time consuming and requires a trained professional, according to the news release.
In addition to simplifying the test and making it quicker, researchers also noted that including two additional factors — the American Society of Anesthesiology’s measurement of physical status for anesthesia, and levels of hemoglobin, the protein in red blood cells that carries oxygen — made it easier to predict postoperative complications, the news release said.
“If you just looked at weight loss and grip strength, those factors were just as good as doing all five steps. And if you add in hemoglobin and ASA scores, the prediction was even better,” study author Viraj Master, MD, PHD, FACS, said in the news release. Master also is associate professor of urology and director of clinical research at Emory. “The nice thing is that the patient’s ASA and hemoglobin are already recorded in the chart before an operation.”
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