"Frailty" is more significant than age when assessing the risks associated with several seemingly low-risk outpatient surgeries, a new study in JAMA Surgery finds.

The researchers define frailty as a "measure of decreased physiological reserve associated with morbidity and mortality independent of chronological age." They list 11 variables corresponding to frailty traits: diabetes, impaired functional status, COPD or pneumonia, congestive heart failure, heart attack within the previous 6 months, percutaneous coronary intervention, heart surgery or angina, treatment for high blood pressure, peripheral vascular disease or rest pain, impaired sensorium, and transient ischemic attack or cerebrovascular accident with persistent residual deficit.

They found that among more than 140,000 patients who'd had outpatient hernia, breast, thyroid, or parathyroid surgery, 1.5% of those with low frailty scores experienced complications, and 0.6% of the low-frailty group had serious complications. But among patients with high frailty scores, 5.8% had complications and 3.0% had serious complications. In fact, say the researchers, there was a stepwise increase in complications correlating with increasing frailty index scores.

The findings highlight the relevance of frailty rather than chronological age in surgical decision-making and preparation, say the authors, adding that "informed consent should be adjusted based on frailty to ensure that patients have an accurate assessment of their risk when making decisions about whether to undergo surgery."

Furthermore, they say, advanced age alone shouldn't be used to prevent patients from having surgery that can improve quality of life and reduce the long-term risk of complications.

Jim Burger