A Preliminary Study on Assessing Optimization of Surgically Frail Patients Comparing Multiple Variables Effecting Prognosis, Outcome, Mortality, and Future Considerations

Abstract

Research Question: Which components of the Edmonton Frailty Scale are most associated with surgical optimization and clinical outcome?

Background and Significance: Surgical optimization is an underused, but highly effective method for preparing patients to undergo procedures in the operating room, which inevitably bear significant stressors upon the body. In addition to the actual time in the operative room, post-operative management of a patient presents an additive variable on the prognosis, recovery, and outcome of patients. There have been scales and calculators that have been implemented in an effort to grasp some objectivity in the management and optimization of patients prior to surgery, one of which is the Edmonton Frailty Scale (EFS). There are several variables that could be potentially correlated, and as a result, controlled and measured using the EFS. The problem facing surgical optimization is determining which factors have measurable differences in the overall outcomes and improvement of patients.

Materials and Methods: We, therefore, hope to address a foundational question that can be built-on by future studies asking, within the realm of cognitive, therapeutic, functional, risk factor assessment, neurological, and psychiatric, which, if any, can be feasibly implemented into surgical optimization with a high enough patient adherence that there can be a measurable difference on prognosis, outcomes, and mortality and morbidity. Several Optimization Components (OC) were implemented with available data including (1) home health physical therapy, (2) cognitive exercises, (3) neuropsychiatric evaluation, and (4) medical management. Individuals who were referred to the optimization clinic for surgery were given a neuropsychiatric evaluation, cognitive exercises, and home health physical therapy, based on their needs and requirements as established by their past medical history, upcoming surgery, and EFS score. With these points of control, the selected population was compared with outcome surrogates for effectiveness and overall outcomes for the implemented OC¿s. The overarching themes for comparison were (1) rate of proceeding to surgery, (2) number of post-operative infections, (3) number of same-day cancellations, and (3) mortality rate. The statistical analysis was separated into several components: (1) EFS compared to length of stay, (2) time between optimization and surgery, (3) proceeding to surgery vs. cancellation of surgery, (4) age and sex, (5) intensive care unit admission, and (6) prior health history and risk factor stratification. By isolating these aspects of the study, the authors hope to lay a foundation for deeper investigation into the implementation and use of the Edmonton Frailty Scale for surgical optimization for patients in a surgical setting.

Results: A total of 167 patients were enrolled in this study and selected as the sample from patients referred to the optimization clinic by surgical subspecialties, including general surgery, orthopedic surgery, vascular surgery, orthopedic surgery, surgical oncology, gynecologic surgery, urology, ophthalmology, and oral maxillofacial surgery. Each patient was evaluated and assessed with standardized lab work, EFS scoring, and committee meeting to determine if patients were eligible and safe to proceed to surgery.

Conclusion: The results and analysis of this data hope to serve as foundation for continued research on the matter.