Comparative assessment of two frailty instruments for risk-stratification in elderly surgical patients: study protocol for a prospective cohort study

BMC Anesthesiology

Study Protocol

Gavin Hamilton¹  Sylvain Gagne²  Homer Yang²  Gregory L. Bryson³  Daniel I. McIsaac⁴  Monica Taljaard⁵  Hussein Moloo⁶  Allen Huang⁷  John Joanisse⁸  Emily Hladkowicz⁹  Alan J. Forster^1,10  Luke T. Lavallée^1,11  Carl van Walraven^1,12  Kednapa Thavorn^1,13  Paul E. Beaule^1,14 

[1] Anesthesiology Resident, University of Ottawa, Ottawa, Canada;Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada;Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada;Ottawa Hospital Research Institute, Ottawa, Canada;Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada;Ottawa Hospital Research Institute, Ottawa, Canada;Department of Anesthesiology, The Ottawa Hospital, Ottawa, Canada;Department of Anesthesiology, The Ottawa Hospital, Ottawa, Canada;School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada;Division of General Surgery, University of Ottawa, Ottawa, Canada;Geriatric Medicine, The Ottawa Hospital, Ottawa, Canada;Hôpital Montfort, Ottawa, Canada;Ottawa Hospital Research Institute, Ottawa, Canada;Ottawa Hospital Research Institute, Ottawa, Canada;Department of Medicine, University of Ottawa, Ottawa, Canada;The Ottawa Hospital, Ottawa, Canada;Ottawa Hospital Research Institute, Ottawa, Canada;Division of Urology, University of Ottawa, Ottawa, Canada;Ottawa Hospital Research Institute, Ottawa, Canada;Institute for Clinical Evaluative Sciences, Toronto, Canada;Medicine and Epidemiology, University of Ottawa, Ottawa, Canada;Ottawa Hospital Research Institute, Ottawa, Canada;School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada;Institute for Clinical Evaluative Sciences, Toronto, Canada;University of Ottawa and The Ottawa Hospital, Ottawa, Canada;

关键词: Geriatrics;    Surgery;    Prognosis;    Disability;    Patient reported outcome measures;    Epidemiology;    Frailty;    Outcomes;   

DOI  :  10.1186/s12871-016-0276-0

 received in 2016-10-12, accepted in 2016-10-25,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundFrailty is an aggregate expression of susceptibility to poor outcomes, owing to age-, and disease-related deficits that accumulate within multiple domains. Older patients who are frail before surgery are at an increased risk of morbidity and mortality, and use a disproportionately high amount of healthcare resources. While frailty is now a well-established risk factor for adverse postoperative outcomes, the perioperative literature lacks studies that: 1) compare the predictive accuracy of different frailty instruments; 2) consider the impact of frailty on patient-reported outcome measures; and 3) consider the acceptability and feasibility of using frailty instruments in clinical practice.MethodsWe will conduct a multicenter prospective cohort study comparing the predictive accuracy of the modified Fried Index (mFI) with the Clinical Frailty Scale (CFS) among consenting patients aged 65 years and older having elective major non-cardiac surgery. The primary outcome will be disability free survival at 90 days after surgery, a patient-reported outcome measure. Secondary outcomes will include complications, length of stay, discharge disposition, readmission and total health system costs. We will compare the accuracy of frailty instruments using the relative true positive rate and relative false positive rate. These measures can be interpreted as the relative difference in the probability of one instrument identifying a true case of death or new disability compared to another instrument, or the relative difference in the probability of one instrument identifying a false case of death or new disability, respectively. We will also assess the acceptability and feasibility of each instrument.DiscussionFrailty is an important prognostic factor in the growing population of older patients having surgery. This study will provide novel findings regarding the choice of an accurate, clinically useable frailty instrument in predicting patient reported outcomes, as well as morbidity, mortality and resource use. These findings will inform current practice and future research.

【 授权许可】

CC BY   
© The Author(s). 2016