Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study.
BACKGROUND
Frailty is associated with early postoperative outcomes. How frailty influences long-term postoperative recovery is poorly described. Our objective was to evaluate the association of frailty with postoperative disability trajectories in the year after surgery.


METHODS
Prespecified 1-yr follow-up of a prospective multicentre cohort study. Patients ≥65 yr were assessed for frailty before major elective noncardiac surgery (Clinical Frailty Scale [CFS] and Fried Phenotype [FP]). The primary outcome was patient-reported disability score (using the WHO Disability Assessment Schedule 2.0) at baseline, 30, 90, and 365 days after surgery. Repeated measures linear regression estimated the association of preoperative frailty with changes in disability scores over time, adjusted for procedure. Group-based trajectory modelling was used to identify subgroup trajectories of people with frailty.


RESULTS
One-year follow-up was complete for 687/702 (97.9%) participants. Frailty was associated with a significant difference in disability trajectory (P<0.0001). Compared with baseline, people with frailty experienced a decrease in disability score at 365 days (CFS frailty: -7.3 points, 95% confidence interval [CI] -10.2 to -4.5); (FP frailty: -5.4 points, 95% CI -8.5 to -2.3); people without frailty had no significant change in their disability score from baseline (no CFS frailty: +0.8 points, 95% CI -1.7 to 3.2; no FP frailty: +1.1 points, 95% CI -3.5 to 1.3). More than one-third of people with frailty experienced an early increase in disability before achieving a net decrease in disability.


CONCLUSIONS
Decision-making and care planning should integrate the possible trade-offs between early adverse outcomes with longer-term benefit when frailty is present in older surgical patients.
['McIsaac|Daniel I|DI|', 'Taljaard|Monica|M|', 'Bryson|Gregory L|GL|', 'Beaulé|Paul E|PE|', 'Gagne|Sylvain|S|', 'Hamilton|Gavin|G|', 'Hladkowicz|Emily|E|', 'Huang|Allen|A|', 'Joanisse|John|J|', 'Lavallée|Luke T|LT|', 'MacDonald|David|D|', 'Moloo|Husein|H|', 'Thavorn|Kednapa|K|', 'van Walraven|Carl|C|', 'Yang|Homer|H|', 'Forster|Alan J|AJ|']
D000368:Aged D000369:Aged, 80 and over D015331:Cohort Studies D004185:Disability Evaluation D005260:Female D005500:Follow-Up Studies D016330:Frail Elderly D000073496:Frailty D015577:Geriatric Assessment D006801:Humans D008297:Male D011183:Postoperative Complications D011446:Prospective Studies D020127:Recovery of Function D012307:Risk Factors D016896:Treatment Outcome
frailty disability postoperative outcome recovery surgery epidemiology