Relationship between frailty and incidence of postoperative complications in older patients undergoing urological procedures– A prospective observational study

Frailty, though not specifically defined, is described as a state of reduced physiological reserves and increased vulnerability to developing dependency and/or mortality when exposed to stressors and a limited ability to compensate and recover from the same.

Surgery and anaesthesia are often a major stressor, and current preoperative evaluation methods still fail to properly estimate the perioperative risk in the elderly. Frailty not only affects mortality rates but is also associated with higher rates of complications and hospitalizations, underlining the threat of lasting physical and cognitive disability following surgery. Frail patients often undergo standard care without appropriate attention or preparation, erroneously expecting the same rate of recovery and functional improvement as their non frail peers.  Frailty measurement is essential for guiding patient care, as it may help clinicians decide which interventions will more likely be beneficial and which may be harmful to specific individuals.

There are many tools to measure frailty that consider a variety of factors including physical function, cognition, comorbidities, self-reported state of health and clinical judgment. A few of them being the Physical Frailty Phenotype (PFP), Deficit Accumulation Index (DAI), the Edmonton Frail Scale (EFS), the Johns Hopkins Adjusted Clinical Groups (JHACG) frailty assessment, the modified Frailty Index 11 (mFI 11), the Fried frailty criteria and the Clinical Frailty Scale

Quality of Recovery (QoR) after anaesthesia is an important measure of the early postoperative health status of the patient. The QoR 15 score provides a valid, extensive and  efficient evaluation of postoperative quality of recovery.

This study aims to assess frailty in patients ≥60 years of age using a questionnaire incorporating both Fried criteria and Clinical Frailty Scale, either at the preoperative anaesthesia clinic or in the peripheral wards. Further, it aims to identify the relationship between frailty status and postoperative complications and quality of recovery in patients undergoing urological surgeries. This analysis does not include patients with emergency procedures or procedures without anaesthesia contribution or operation. This study will also help us determine whether Frailty assessment should be included in routine preanesthetic workup of elderly. This knowledge will help us to tailor-make the management plan for each patient, including surgical and anaesthetic technique, adequate optimisation prior to surgery and in certain indicated cases even reconsidering non-surgical management so as to provide a better quality of recovery.