Too Frail for Surgery? Initial Results of a Large Multidisciplinary Prospective Study Examining Preoperative Variables Predictive of Poor Surgical Outcomes Louis M Revenig, BS, Daniel J Canter, MD, Maxwell D Taylor, BA, Caroline Tai, MPH, John F Sweeney, MD, FACS, Juan M Sarmiento, MD, FACS, David A Kooby, MD, FACS, Shishir K Maithel, MD, FACS, Viraj A Master, MD, PhD, FACS, Kenneth Ogan, MD BACKGROUND: The decision as to whether a patient can tolerate surgery is often subjective and can misjudge a patient’s true physiologic state. The concept of frailty is an important assessment tool in the geriatric medical population, but has only recently gained attention in surgical patients. Frailty potentially represents a measureable phenotype, which, if quantified with a standard- ized protocol, could reliably estimate the risk of adverse surgical outcomes. STUDY DESIGN: Frailty was prospectively evaluated in the clinic setting in patients consenting for major general, oncologic, and urologic procedures. Evaluation included an established assessment tool (Hopkins Frailty Score), self-administered questionnaires, clinical assessment of performance status, and biochemical measures. Primary outcome was 30-day postoperative complications. RESULTS: There were189 patients evaluated: 117 from urology, 52 from surgical oncology, and 20 from general surgery clinics. Mean age was 62 years, 59.8% were male, and 71.4% were Caucasian. Patients who scored intermediately frail or frail on the Hopkins Frailty Score were more likely to experience postoperative complications (odds ratio [OR] 2.07, 95% CI 1.05 to 4.08, p ¼ 0.036). Of all other preoperative assessment tools, only higher hemoglobin (p ¼ 0.033) had a significant association and was protective for 30-day complications. CONCLUSIONS: The aggregate score of patients as “intermediately frail or frail” on the Hopkins Frailty Score was predictive of a patient experiencing a postoperative complication. This preoperative assessment tool may prove beneficial when weighing the risks and benefits of surgery, allow- ing objective data to guide surgical decision-making and patient counseling. (J Am Coll Surg 2013;217:665e670. Ó 2013 by the American College of Surgeons) The decision of whether or not a patient will tolerate a surgical procedure is overly subjective, especially in the elderly and/or comorbid population due to the paucity of standardized, easily reproducible tools to predict postoperative outcomes. 1 This subjectivity is highlighted by the observation that there is significant discordance between different perceptions of 10-year life expectancy between physicans. 2 Many of the commonly used instru- ments to assess preoperative risk do not take into account a patient’s physiologic reserve, and instead account only for existing deficits of discrete organ systems. 3 Addition- ally, cognitive impairments have been linked by geriatri- cians to poor outcomes in the elderly, and are not components of the traditional surgical risk indices. 4,5 A standardized, verified, preoperative risk assessment tool accounting for these considerations would aid surgeons’ preoperative decision-making in hopes of limiting postsur- gical complications and improving health outcomes. In order to better understand the functional and phys- iologic heterogeneity among the elderly, the concept of Disclosure information: Nothing to disclose. Presented at the Southeastern Section of the American Urological Associa- tion meeting, March 2013, Williamsburg, VA. Received April 9, 2013; Revised May 17, 2013; Accepted June 20, 2013. From the Departments of Urology (Revenig, Canter, Taylor, Tai, Master, Ogan), General Surgery (Sweeney, Sarmiento), and Surgical Oncology (Kooby, Maithel), Emory University School of Medicine, and The Winship Cancer Institute (Canter, Sarmiento, Kooby, Maithel, Master, Ogan), Atlanta, GA. Correspondence address: Kenneth Ogan, MD, Department of Urology, Emory University School of Medicine, 1365 Clifton Rd NE, Building B, Suite 1400, Atlanta, GA 30322. email: kogan@emory.edu 665 ª 2013 by the American College of Surgeons ISSN 1072-7515/13/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jamcollsurg.2013.06.012