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The Use of Frailty Scores for Screening the Surgical Risk Benefits: A Multidisciplinary Approach
Madison M Ballacchino1, Chloe C McQuestion1, Matthew S Giuca2
1Departments of Anesthesiology and Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY.
Objective:
To examine the role of Multidisciplinary Surgical Pause Committees (MDSPCs) in perioperative planning to reduce adverse postoperative events and mortality rates.
Background:
Frail patients could benefit from preoperative MDSPCs when utilizing risk-benefit ratios for the proposed surgical plan. We examined whether MDSPCs improved clinical outcomes by developing individualized care plans and stratifying patients based on their level of frailty and ability to overcome external stressors.
Methods:
We retrospectively collected patient information after MDSPC evaluation, at our medical center for 12 years since 2011. Patient's frailty Risk Analysis Index (RAI) scores were calculated, and survival status was updated. MDSPCs plans were put into the following categories: proceed with the planned surgery (G1), proceed after medical optimization (G2), reduce the invasiveness of surgery or anesthesia plan (G3), or adopt a nonsurgical approach (G4). χ 2 and independent t tests were used for categorical and numerical data, respectively. Survival analysis for 30-day (primary endpoint), 1-year, and overall mortality rates used Kaplan-Meier. The alpha was set at 0.05.
Results:
Clinical information was accessed from 12 women and 382 men. The average age was 71 ± 11 years. Of planned surgical operations, 87.3% were stratified as American Society of Anesthesiologists class III and IV. RAI scores were 36.4 ± 9.6 (G1), similar to 37.4 ± 10.8 (G2) but lower than 41.4 ± 9.3 (G3) and 44.2 ± 9.7 (G4; P < 0.001). Average survival duration was 35 months (G1), 35 months (G2), both significantly longer than 20 months (G3) and 18 months (G4; P < 0.001).
Conclusions:
Medical optimization improved overall survival and reduced death within 30 days and 1 year to be comparable to G1. In addition, reducing the surgical invasiveness only improved survival advantage for 6 months, after which it was comparable to those in G4 with the worst outcome. RAI scoring is an excellent tool to predict the outcome of surgery, and it was used successfully in critically ill patients.
