• Yibo Li, Jenelle L Pederson, Thomas A Churchill, Adrian S Wagg, Jayna M Holroyd-Leduc, Kannayiram Alagiakrishnan, Raj S Padwal, and Rachel G Khadaroo.
• Departments of Surgery (Li, Pederson, Churchill, Khadaroo), Medicine (Wagg, Alagiakrishnan, Padwal) and Critical Care Medicine (Khadaroo), University of Alberta; Alberta Seniors Health Strategic Clinical Network (Wagg, Alagiakrishnan), Alberta; Departments of Medicine (Holroyd-Leduc) and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta.
• CMAJ. 2018 Feb 20; 190 (7): E184-E190.

BackgroundFrailty is a state of vulnerability to diverse stressors. We assessed the impact of frailty on outcomes after discharge in older surgical patients.MethodsWe prospectively followed patients 65 years of age or older who underwent emergency abdominal surgery at either of 2 tertiary care centres and who needed assistance with fewer than 3 activities of daily living. Preadmission frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale as "well" (score 1 or 2), "vulnerable" (score 3 or 4) or "frail" (score 5 or 6). We assessed composite end points of 30-day and 6-month all-cause readmission or death by multivariable logistic regression.ResultsOf 308 patients (median age 75 [range 65-94] yr, median Clinical Frailty Score 3 [range 1-6]), 168 (54.5%) were classified as vulnerable and 68 (22.1%) as frail. Ten (4.2%) of those classified as vulnerable or frail received a geriatric consultation. At 30 days after discharge, the proportions of patients who were readmitted or had died were greater among vulnerable patients (n = 27 [16.1%]; adjusted odds ratio [OR] 4.60, 95% confidence interval [CI] 1.29-16.45) and frail patients (n = 12 [17.6%]; adjusted OR 4.51, 95% CI 1.13-17.94) than among patients who were well (n = 3 [4.2%]). By 6 months, the degree of frailty independently and dose-dependently predicted readmission or death: 56 (33.3%) of the vulnerable patients (adjusted OR 2.15, 95% CI 1.01-4.55) and 37 (54.4%) of the frail patients (adjusted OR 3.27, 95% CI 1.32-8.12) were readmitted or had died, compared with 11 (15.3%) of the patients who were well.InterpretationVulnerability and frailty were prevalent in older patients undergoing surgery and unlikely to trigger specialized geriatric assessment, yet remained independently associated with greater risk of readmission for as long as 6 months after discharge. Therefore, the degree of frailty has important prognostic value for readmission.Trial Registration For Primary StudyClinicalTrials.gov, no. NCT02233153.© 2018 Joule Inc. or its licensors.

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