Too frail for surgery? A frailty index in major colorectal surgery

Background: Frailty is defined as increased vulnerability from accumulating morbidities in multiple organ systems. Evidence suggests frailty indices predict surgical outcomes in elderly patients. We assessed the validity of a frailty index in predicting post-operative outcomes in major colorectal surgery.

Methods: A retrospective review of a prospective database was studied. Patients aged less than 65 years were excluded. Patients were assessed using a validated National Surgical Quality Improvement Program frailty index. Endpoints included intensive care unit (ICU) stay, post-operative complications and 30-day post-operative mortality, and also compared using American Society of Anesthesiologists (ASA) grade and P-Possum CR.

Results: Of the 205 patients, 43 (21%) were frail and 162 (79%) were not frail. Seven percent of frail patients required ICU stay compared with 6% non-frail patients (P > 0.05, NS). P-Possum in frail versus non-frail groups in ICU was 48% versus 8.6% (P < 0.05). Forty percent of frail and 26% non-frail patients developed post-operative complications (P > 0.05, NS) with mean P-Possum of 23% versus 12% in these groups, respectively (P < 0.05). Five percent of frail patients and 2.5% non-frail patients died within 30 days of surgery (P > 0.05, NS) with a mean P-Possum of 43% versus 7% in these groups, respectively (P > 0.05, NS).

Conclusions: These data demonstrate that frail patients who developed complications, died within 30 days and required admission to ICU had significantly higher P-Possum CR scores. However, the P-Possum CR score is a superior predictor of post-operative outcomes than frailty index alone.