JHSM
Journal of Health Sciences and Medicine

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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Original Article
The effects of frailty on quality of recovery and complications in older adults undergoing major abdominal surgery: a prospective cohort study
Abstract
Aims: There is an increase in the number of older people who have undergone surgical intervention in proportion to the aging of the global population. This situation creates the need to adapt surgical care according to the pathophysiological profile of older people. Recently, it has been argued that chronological age alone does not explain biological age, and frailty will be an appropriate parameter in organizing surgical care of older people. This study aimed to determine the effect of frailty on 30-day postoperative complications and quality of recovery in older people undergoing major abdominal surgery.
Methods: A prospective cohort study was conducted in the General Surgery Department of the Erciyes University Medical Center in Türkiye. Overall, 222 patients aged 65 and over underwent major abdominal surgery between February 2021 and 2023. Frailty was determined using Fried Frailty Index. 30-day postoperative complications were evaluated using the Clavien Dindo Classification. Quality of recovery- 40 (QoR-40) was filled three days after surgery to determine the quality of recovery of the patients. Receiver-operating characteristic curves analysis was used to evaluate the ability to predict 30-day complications of frailty. Univariate linear regression analysis was performed to determine frailty to be an independent predictor of the QoR-40.
Results: The majority of the participants were male (56.8%), the mean age was 71.41±5.29 years, and 50% of patients were frail. Frail patients (28.1%) showed a higher rate of major complications compared to non-frail patients (9.3%). The Fried frailty index score significantly predicted 30-day postoperative complications (AUC=0.653, 95%=0.565-0.741). The total mean score of the QoR-40 scale was 147.09±15.82. Univariate linear regression analysis found frailty (OR -3.81, 95% CI -4.79- -2,83), age (OR -0,46, 95% CI -0,79- -0,12), Charlson comorbidity index (OR -2,40, 95% CI -3,23- -1,57), and operation time (OR -0,04, 95% CI -0,06- -0,02) as independent predictors of quality of recovery.
Conclusion: Frailty is a significant predictor for 30-day postoperative complications and quality of recovery in older people undergoing major abdominal surgery.

Keywords : Frailty, abdominal surgery, quality of recovery, postoperative complication, older people

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1. Rafalimanana H. World Population Ageing. Economic and SocialAffairs United Nations. 2020. 1-47 p. Available from: http://link.springer.com/chapter/10.1007/978-94-007-5204-7_6
2. Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY,Esnaola NF. Optimal Perioperative Management of the GeriatricPatient: Best Practices Guideline from ACS NSQIP® /AmericanGeriatrics Society. J Am Coll Surg. 2016;222:930-4(5):930-934.
3. Ayan FS, Dagtekin T. Geriatrik cerrahide güncel yaklaşımlar.İstanbul Gelişim Üniv Sağ Bil Derg. 2020;12(12):460-474.
4. Office for National Statistics. Estimates of the Very Old (includingCentenarians): England and Wales, and United Kingdom,2002 to 2014. 2015. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/bulletins/estimatesoftheveryoldincludingcentenarians/previousReleases
5. Partridge JSL, Moonesinghe SR, Lees N, Dhesi JK. Perioperativecare for older people. Age Ageing. 2022;51(8):1-6.
6. Simões CM, Carmona MJC, Hajjar LA, et al. Predictors of majorcomplications after elective abdominal surgery in cancer patients.BMC Anesthesiol. 2018;18(1):1-8.
7. Kassahun WT, Babel J, Mehdorn M. Assessing differences insurgical outcomes following emergency abdominal exploration forcomplications of elective surgery and high-risk primary emergencies.Sci Rep. 2022;12(1):1-10. doi:10.1038/s41598-022-05326-4
8. British Geriatrics Society. Guideline for the care of people livingwith frailty undergoing elective and emergency surgery thatencompasses the whole perioperative pathway. 2021. Availablefrom: https://www.bgs.org.uk/cpocfrailty
9. Pang CL, Gooneratne M, Partridge JSL. Preoperative assessmentof the older patient. BJA Educ. 2021;21(8):314-320. doi:10.1016/j.bjae.2021.03.005
10. Sandini M, Pinotti E, Persico I, Picone D, Bellelli G, GianottiL. Systematic review and meta-analysis of frailty as a predictorof morbidity and mortality after major abdominal surgery. BJSOpen. 2017;1(5):128-137.
11. Chen Y, Wang J, Liu S, et al. Development and validation of theChinese version of the quality of recovery-40 questionnaire. TherClin Risk Manag. 2020;16:1165-1173.
12. Gornall BF, Myles PS, Smith CL, et al. Measurement of quality ofrecovery using the QoR-40: a quantitative systematic review. Br JAnaesth. 2013;111(2):161-169.
13. Christner S, Ritt M, Volkert D, Wirth R, Sieber CC, Gaßmann KG.Evaluation of the nutritional status of older hospitalised geriatricpatients: a comparative analysis of a Mini Nutritional Assessment(MNA) version and the Nutritional Risk Screening (NRS 2002). JHum Nutr Diet. 2016;29(6):704-713.
14. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new methodof classifying prognostic comorbidity in longitudinal studies:development and validation. J Chronic Dis. 1987;40(5):373-383.
15. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: Evidencefor a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):146-156.
16. Manekk RS, Gharde P, Gattani R, Lamture Y. Surgical complicationsand its grading: a literature review. Cureus. 2022;14(5):e24963.
17. Dindo D, Demartines N, Clavien PA. Classification of surgicalcomplications: A new proposal with evaluation in a cohort of 6336patients and results of a survey. Ann Surg. 2004;240(2):205-213.
18. Myles P, Weitkamp B, Jones K, Melick J, Hensen S. Validity andreliability of a postoperative quality of recovery score: The QoR-40. Br J Anaesth. 2000;84(1):11-15.
19. Karaman S, Arici S, Dogru S, et al. Validation of the Turkishversion of the quality of recovery-40 questionnaire. Health QualLife Outcomes. 2014;12(1):1-6.
20. Yin Y, Jiang L, Xue L. Comparison of three frailty measures for 90-day outcomes of elderly patients undergoing elective abdominalsurgery. ANZ J Surg. 2021;91(3):335-340.
21. Aguilar-Frasco JL, Rodríguez-Quintero JH, Moctezuma-Velázquez P, et al. Frailty index as a predictive preoperative toolin the elder population undergoing major abdominal surgery:a prospective analysis of clinical utility. Langenbeck’s Arch Surg.2021;406(4):1189-1198.
22. Than TNH, Nguyen T, Nguyen TTT, Pham T. Frailty and adverseoutcomes among older patients undergoing gastroenterologicalsurgery in vietnam. J Multidiscip Healthc. 2021;14:2695-703.
23. Kennedy CA, Shipway D, Barry K. Frailty and emergencyabdominal surgery: a systematic review and meta-analysis.Surgeon. 2022;20(6):307-314. doi:10.1016/j.surge.2021.11.009
24. Han B, Li Q, Chen X. Effects of the frailty phenotype on post-operative complications in older surgical patients: a systematicreview and meta-analysis. BMC Geriatr. 2019;19(1):1-9.
25. Aceto P, Perilli V, Luca E, et al. Predictive power of modified frailtyindex score for pulmonary complications after major abdominalsurgery in the elderly: a single centre prospective cohort study.Eur Rev Med Pharmacol Sci. 2021;25(10):3798-3802.
26. Tan HL, Chia STX, Nadkarni NV, Ang SY, Seow DCC, Wong TH.Frailty and functional decline after emergency abdominal surgeryin the elderly: A prospective cohort study. World J Emerg Surg.2019;14(1):1-7.
27. Li JL, Henderson MA, Revenig LM, et al. Frailty and one-yearmortality in major intra-abdominal operations This study waspresented at the World Congress of Endourology in London inOctober 2015. J Surg Res. 2016;203(2):507-512. doi:10.1016/j.jss.2016.03.007
28. Parmar KL, Pearce L, Farrell I, Hewitt J, Moug S. Influence offrailty in older patients undergoing emergency laparotomy: a UK-based observational study. BMJ Open. 2017;7(10):1-5.
29. Oreskov JO, Burcharth J, Nielsen AF, Ekeloef S, Kleif J, GögenurI. Quality of recovery after major emergency abdominalsurgery: a prospective observational cohort study. Minerva Chir.2020;75(2):104-110.
30. Günel B, Özşaker E. Investigation of the relationship betweenthe level of vulnerability and recovery quality of elderly patientshospitalized in the neurosurgery clinic. Ege üniversitesi; 2021.
31. Wessels E, Perrie H, Scribante J, Jooma Z. Quality of recoveryfollowing orthopedic surgery in patients at an academic hospitalin South Africa. Anesth Analg. 2021;133(2):507-514.
32. Chazapis M, Walker EMK, Rooms MA, Kamming D, MoonesingheSR. Measuring quality of recovery-15 after day case surgery. Br JAnaesth. 2016;116(2):241-248.
33. Marinho R, Lusquinhos J, Carvalho B, Azevedo J, Santos A, AbelhaF. Quality of recovery after surgery for cancer treatment. RevEspañola Anestesiol y Reanim. 2018;65(8):426-433. doi:10.1016/j.redare.2018.04.012
34. Ferraz SM, Moreira JP, Mendes LC, et al. Evaluation of the qualityof recovery and the postoperative health status after electivesurgery. Brazilian J Anesthesiol. 2018;68(6):577-583.
35. Guimarães-Pereira L, Costa M, Sousa G, Abelha F. Quality ofrecovery after anaesthesia measured with QoR-40: a prospectiveobservational study. Brazilian J Anesthesiol. 2016;66(4):369-375.
36. Marinho R, Lusquinhos J, Carvalho B, Azevedo J, Santos A,Abelha F. Quality of recovery after surgery for cancer treatment.Rev Española Anestesiol y Reanim. 2018;65(8):426-433.
37. Liu C, Gao W, Zhou L, et al. Can the Tilburg Frailty Indicatorpredict post-operative quality of recovery in patients withgynecologic cancer? a prospective cohort study. Int J GynecolCancer. 2023;33(5):1-6.
Article available in :
Volume 6, Issue 5, 2023
Page : 1133-1141
https://doi.org/10.32322/jhsm.1350264
Article Information
Received : 28 Ağu 2023
Accepted : 18 Eyl 2023
Published : 28 Eyl 2023
Corresponding Author :

Hatice Yüceler Kaçmaz: Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey

[email protected]
Citation : Yüceler Kaçmaz H, Kahraman H, Gök M, Akın S, Sözüer E. The effects of frailty on quality of recovery and complications in older adults undergoing major abdominal surgery: a prospective cohort study. J Health Sci Med. 2023;6(5):1133-1141.

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