Purpose

Identifying patients at risk of postoperative complications and trying to prevent these complications are the essence of preoperative evaluation. While not overtly frail or disabled, vulnerable patients with mild frailty may be missed by routine assessments and may still have a worse postoperative course.

Methods

We performed a prospective cohort study evaluating vulnerability in older patients undergoing elective surgery. Vulnerability was assessed using the Clinical Frailty Scale. Our primary outcome was postoperative hospital length of stay (LOS) and our secondary outcome was non-home hospital discharge. We performed multivariable analyses to assess the association between vulnerability and our primary and secondary outcome.

Results

Between 1 January 2017 and 1 January 2018, 271 older patients with a median [interquartile range (IQR)] age of 72 [69–76] yr underwent frailty assessment prior to surgery. Eighty-eight (32.5%) of the cohort were classified as vulnerable. The median [IQR] duration of hospital LOS was 4 [2–7] days for vulnerable patients, 4 [2–6] days for robust patients, and 7 [3–10] days for frail patients. After adjusting for confounders, hospital LOS was not longer for vulnerable patients than for robust patients, but was associated with a higher rate of non-home discharge (odds ratio, 3.7; 95% confidence interval, 1.1 to 12.9; P = 0.04).

Conclusions

Vulnerability was not associated with a longer hospital LOS but with higher risk of non-home discharge. Vulnerable patients might benefit from early identification and advanced planning with earlier transfer to rehabilitation centres.

中文翻译：

---

弱势老年患者接受择期大手术的结果：一项前瞻性队列研究。

目的

识别有术后并发症风险的患者并试图预防这些并发症是术前评估的关键。虽然不是很脆弱或很残疾，但常规评估可能会忽略轻度脆弱的脆弱患者，并且术后病程可能还会更糟。

方法

我们进行了一项前瞻性队列研究，评估了接受择期手术的老年患者的脆弱性。使用临床脆弱量表评估脆弱性。我们的主要结果是术后住院时间（LOS），次要结果是非家庭出院。我们进行了多变量分析，以评估脆弱性与我们的主要和次要结果之间的关联。

结果

在2017年1月1日至2018年1月1日之间，对271例中位[四分位间距（IQR）]年龄为72 [69-76]岁的老年患者进行了手术前的脆弱性评估。该队列中有88个（32.5％）被归类为弱势人群。弱势患者住院LOS的中位[IQR]持续时间为4 [2-7]天，健壮患者为4 [2-6]天，体弱患者为7 [3-10]天。在对混杂因素进行调整后，脆弱患者的住院时间不再比健壮患者长，但与非家庭出院率更高相关（赔率，3.7； 95％置信区间，1.1至12.9；P  = 0.04）。

结论

脆弱性与更长的医院服务水平无关，但与非出院风险更高。易受伤害的患者可能会受益于及早转移到康复中心的早期识别和高级计划。