The prevalence and trajectory of frailty in older surgical patients: A longitudinal multicentre cohort study

BACKGROUND: Frailty is a state of increased vulnerability and decreased physiological reserve, which can reduce one's capacity to cope with external stressors such as a major surgery. We aimed to (1) investigate the preoperative and postoperative prevalence of frailty in older surgical patients; and (2) evaluate preoperative risk factors associated with postoperative frailty. METHODS: This multicentre prospective study included 307 non-cardiac surgical patients aged ≥65 years. Clinical frailty was assessed online using the five-item FRAIL scale (Fatigue, Resistance, Ambulation, Illness, weight-Loss) preoperatively and postoperatively at 30, 90, and 180 days. Trajectories of FRAIL scores were assessed with linear mixed-effects models, stratified by preoperative frailty. Preoperative risk factors associated with frailty at 180 days were explored by logistic regression. RESULTS: Preoperatively, 36% of patients were robust, 52% were prefrail, and 12% were frail. Frail patients experienced a significant improvement in frailty by 90 and 180 days. Prefrail patients experienced a transient worsening of frailty level with subsequent improvement by 180 days. Robust patients experienced similar worsening in frailty but remained clinically robust, despite a small absolute difference in FRAIL score. Preoperative frailty and functional disability were both associated with greater odds of 180-day frailty (aOR 2.65, 95% CI [1.51, 4.97] and aOR 4.71, 95% CI [1.41, 15.65], respectively). CONCLUSIONS: The prevalence of preoperative prefrailty and frailty was high among older surgical patients. A high preoperative FRAIL score and severe functional disability were associated with greater odds of postoperative 180-day frailty. Preoperative frailty assessment can risk-stratify patients and inform postoperative targets. REGISTRATION: The trial was registered on www. CLINICALTRIALS: gov on April 7, 2021 (NCT04850833).