The Use of Frailty Scores for Screening the Surgical Risk Benefits: A Multidisciplinary Approach

Area of Science:

• Perioperative Medicine
• Surgical Outcomes Research
• Geriatric Surgery

Background:

• Frail patients may benefit from preoperative multidisciplinary surgical pause committees (MDSPC) to optimize surgical planning.
• Risk-benefit assessments and individualized care plans are crucial for frail patients undergoing surgery.
• Stratifying patients by frailty and resilience aids in tailoring perioperative strategies.

Purpose of the Study:

• To evaluate the impact of MDSPCs on perioperative planning.
• To assess the role of MDSPCs in reducing adverse postoperative events and mortality rates.
• To determine the effectiveness of different MDSPC recommendations on patient outcomes.

Main Methods:

• Retrospective analysis of 12 years of patient data following MDSPC evaluation.
• Calculation of frailty risk assessment index (RAI) scores and survival status updates.
• Categorization of MDSPC plans: G1 (proceed), G2 (optimize medically), G3 (reduce invasiveness), G4 (non-surgical). Survival analysis using Kaplan-Meier curves.

Main Results:

• Analysis included 404 patients (12 women, 382 men), average age 71±11 years; 87.3% ASA class III/IV.
• Higher RAI scores correlated with poorer outcomes (G3/G4 vs. G1/G2).
• Average survival: 35 months (G1/G2) vs. 18-20 months (G3/G4), P<0.001.

Conclusions:

• Medical optimization (G2) improved survival to levels comparable with proceeding directly to surgery (G1).
• Reducing surgical invasiveness (G3) provided only a short-term survival benefit, with outcomes similar to non-surgical approaches (G4) long-term.
• RAI scoring is a valuable tool for predicting surgical outcomes, particularly in critically ill patients.