BACKGROUND Frail older adults are at increased risk of post-operative morbidity compared with robust counterparts. Simple methods testing frailty such as grip strength or gait speed have shown promising results for predicting post-operative outcome, but there is a debate regarding the most appropriate and precise frailty assessment method. We compared the predictive value of multidimensional frailty score (MFS) with grip strength, gait speed, or conventional risk stratification tool for predicting post-operative complications in older surgical patients. METHODS From January 2016 to June 2017, 648 older surgical patients (age ≥ 65 years) were included for analysis. MFS was calculated based on the preoperative comprehensive geriatric assessment. Grip strength and gait speed were measured before surgery. The primary outcome was a composite of post-operative complications (e.g. pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). The secondary outcome was the 6 month all-cause mortality. RESULTS Among 648 patients (mean age 76.6 ± 5.4 years, 52.8% female), 66 (10.2%) patients experienced post-operative complications, and the 6 month mortality was 3.9% (n = 25). Grip strength, gait speed, MFS, and American Society of Anesthesiologists (ASA) classification could predict post-operative complication but only MFS (hazard ratio = 1.581, 95% confidence interval 1.276-1.959, P < 0.001) could predict 6 month mortality after adjustment. MFS (C-index = 0.750) had a superior prognostic utility compared with age (0.638, P = 0.008), grip strength (0.566, P < 0.001), and ASA classification (0.649, P = 0.004). MFS improved the predictive value on age [C-index of 0.638 (age) vs. 0.758 (age + MFS), P < 0.001] and ASA classification [C-index of 0.649 (ASA) vs. 0.765 (ASA + MFS), P < 0.001] for post-operative complication; however, gait speed or grip strength did not provide additional prognostic value in both age and ASA. CONCLUSIONS Multidimensional frailty score based on preoperative comprehensive geriatric assessment showed better utility than age, grip strength, gait speed, or ASA classification for predicting post-operative complication and 6 month mortality. MFS also showed incremental predictive ability for post-operative complications with the addition of age and ASA classification. Accordingly, MFS is superior to grip strength or gait speed for predicting complications among older surgical patients.

中文翻译：

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比较老年手术患者的多维虚弱评分，握力和步态速度。

背景技术与健壮的同龄人相比，年老体弱的成年人术后发病的风险增加。测试脆弱性（例如握力或步态速度）的简单方法已显示出可预测手术结果的有希望的结果，但是关于最合适和最精确的脆弱性评估方法存在争议。我们将多维虚弱评分（MFS）与握力，步态速度或常规风险分层工具的预测值进行了比较，以预测老年手术患者的术后并发症。方法纳入2016年1月至2017年6月的648例年龄≥65岁的老年手术患者。MFS是根据术前综合老年医学评估得出的。术前测量握力和步态速度。主要结局是术后并发症（例如肺炎，尿路感染，ir妄，急性肺血栓栓塞和计划外的重症监护病房）的综合结果。次要结果是6个月全因死亡率。结果648例患者（平均年龄76.6±5.4岁，女性52.8％）中，有66例（10.2％）发生了术后并发症，并且6个月死亡率为3.9％（n = 25）。握力，步态速度，MFS和美国麻醉医师学会（ASA）分类可以预测术后并发症，但只有MFS（危险比= 1.581，95％置信区间1.276-1.959，P <0.001）可以预测术后6个月的死亡率。调整。与年龄（0.638，P = 0.008），握力（0.566，P <0.001）相比，MFS（C-指数= 0.750）具有更好的预后功能，和ASA分类（0.649，P = 0.004）。MFS提高了年龄预测值[C指数为0.638（年龄）vs. 0.758（年龄+ MFS），P <0.001]和ASA分类[C指数为0.649（ASA）vs. 0.765（ASA + MFS），术后并发症P <0.001]；但是，步态速度或握力对年龄和ASA均无附加的预后价值。结论基于术前综合老年医学评估的多维虚弱评分显示，比年龄，握力，步态速度或ASA分类可更好地预测术后并发症和6个月的死亡率。MFS还显示出随着年龄和ASA分类的增加对术后并发症的预测能力。因此，