Frailty, not old age - a risk factor for surgical complications

Dr. Jennifer Watt, at the University of Toronto & colleagues, have found in a study that although surgeons often consider age when assessing elderly patients’ odds of postoperative complications, age did not appear to influence the risk. Older adults may not necessarily be at risk for surgery complications just because of their age, but their risk for serious complications may be at least doubled if they’re frail or suffering from dementia.

The study team examined data from 44 studies of postoperative complications among almost 13,000 patients and found that, overall, about one in four elderly people experienced complications after surgery.

“Frailty and cognitive impairment are geriatric syndromes, whereas age is merely a reflection of how long someone has been alive,” said lead study author Dr. Jennifer Watt, a geriatrician at the University of Toronto and the Li Ka Shing Knowledge Institute of St. Michael’s Hospital.

Geriatric syndromes like frailty and cognitive impairment were associated with higher odds of complications like pneumonia, infections and blood clots, the researchers report in BMC Medicine.

Frailty, in particular, was also associated with longer hospital stays, especially among frail patients who also experienced postoperative complications.

In addition, frailty was linked to a greater chance that patients would be moved to another hospital or to a nursing home or another type of institutional setting and not discharged to their own home.

One limitation of the analysis is that many of the smaller studies used varied methods to look at the relationship between age and complications after surgery, making it difficult for researchers to calculate meaningful differences in outcomes based on specific risk factors.

Even so, the findings highlight a need for surgeons to assess elderly patients’ risk of complications using a more nuanced approach that considers how well they function in daily life, said Dr. Carolyn Dacey Seib of the UCSF Medical Center in San Francisco.

“The most likely reason that age was not an independent predictor of complications is that other geriatric syndromes, such as frailty, cognitive impairment, and functional decline, are more representative of a patient’s surgical risk than chronological age,” Seib, who wasn’t involved in the study, said by email.

“This doesn’t mean that frail or cognitively impaired patients should not ever undergo surgery,” Seib added. “It means they or their decision-makers should be informed of their risk and should be able to make an individualized decision about whether the potential benefit is worth the risk is given what is most important to them.”