Rates of Postoperative Mortality High for Frail, Very Frail Patients

Rates of postoperative mortality high across all levels of the Operative Stress Score for frail patients

WEDNESDAY, Nov. 27, 2019 (HealthDay News) -- Patients who are frail and very frail have high rates of postoperative mortality across all levels of operative stress, according to a study published online Nov. 13 in JAMA Surgery.

Myrick C. Shinall Jr., M.D., Ph.D., from the Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues examined the correlation between frailty and mortality at varying levels of operative stress as measured by the Operative Stress Score among veterans who underwent a noncardiac surgical procedure. Surgical procedures were stratified into five categories of physiologic stress.

Of 432,828 unique patients, 8.5 and 2.1 percent were frail and very frail, respectively. The researchers found that the 30-day mortality rate was 1.55 percent among patients who were frail and underwent the lowest-stress surgical procedure and 5.13 percent among patients with frailty who underwent moderate-stress surgical procedures -- both exceeding the 1 percent mortality rate used to define high-risk surgery. The 30-day mortality rates were higher after the lowest-stress surgical procedure and moderate-stress surgical procedures among patients who were very frail (10.34 and 18.74 percent, respectively). Mortality continued to increase at 90 and 180 days for patients who were frail and very frail, reaching 43 percent at 180 days after moderate-stress surgical procedures for very frail patients.

"Efforts to screen patients for frailty should not only focus on high-stress surgical procedures but should also focus on the low-stress surgical procedures, which are also risky among patients who are frail," the authors write.

One author holds a patent for a device that measures patient frailty.

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