Association of Preoperative Patient Frailty and Operative Stress With Postoperative Mortality

Area of Science:

• Geriatric Medicine
• Surgical Outcomes
• Public Health

Background:

• Patients with frailty face elevated risks for postoperative mortality and complications.
• Existing research often overlooks the impact of frailty across diverse surgical procedure stress levels.

Purpose of the Study:

• To evaluate the association between patient frailty and mortality rates.
• To assess mortality risk at varying operative stress levels using a novel Operative Stress Score.

Main Methods:

• Retrospective cohort study of veterans (2010-2014) from the Veterans Administration Surgical Quality Improvement Program.
• Utilized the Risk Analysis Index for frailty assessment and a novel Operative Stress Score for procedure stress stratification.
• Analyzed 30, 90, and 180-day postoperative mortality.

Main Results:

• Frailty was identified in 8.5% and very frail in 2.1% of 432,828 patients.
• Frail patients undergoing low-stress procedures had a 1.55% 30-day mortality rate, exceeding thresholds for high-risk surgery.
• Very frail patients showed significantly higher mortality rates across all operative stress levels, reaching 43% at 180 days for moderate-stress procedures.

Conclusions:

• A novel Operative Stress Score effectively quantifies surgical physiologic stress.
• Frailty is a critical predictor of postoperative mortality, irrespective of operative stress level.
• Universal frailty screening is recommended, as low- and moderate-stress procedures can be high-risk for frail individuals.