In a new study, researchers found that the threshold for when to perform elective surgery in a frail patient may be much higher than previously thought.
The research was conducted by a team at UT Health San Antonio and elsewhere.
Frailty is a clinical syndrome marked by slow walking speed, weak grip, poor balance, exhaustion, and low physical activity.
Frail individuals have increased vulnerability to events such as falls and disability.
Previous studies have demonstrated that frail patients have higher rates of complications and mortality; however, these studies have focused on higher-risk surgical procedures.
The study involved 432,828 patients treated in veterans hospitals between 2010 and 2014 and found that frail patients were more likely to die within 30, 90 and 180 days after surgery than non-frail patients.
This was true even after low-stress surgical procedures such as cystoscopy (scope of the bladder) and moderate-stress procedures such as laparoscopic cholecystectomy (minimally invasive gallbladder removal).
The 30-day mortality rate among frail patients after a low-stress procedure was 1.55%. For frail patients who underwent a moderate-stress surgery, it was 5.13%.
These rates are higher than the 1% mortality rate often used to define high-risk surgery.
The team says the study offers guidance to surgeons, patients, and families about whether a frail patient should undergo surgery, particularly elective procedures.
Perhaps frail individuals have better things to do with their remaining time than recovering from elective surgery.
Because the study examined a population of veteran patients who were almost all men, further research is needed.
The team will apply the same methods from the current study to health care outcomes data from non-veterans in three civilian health systems.
One author of the study is Paula Shireman, M.D., M.S., M.B.A.
The study is published in the journal JAMA Surgery.
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