Frailty Test Predicts Surgical Outcomes in Older Patients

A 10-minute “frailty” test administered to older patients
before they undergo surgery can predict with their risk for complications, how
long they will stay in the hospital and whether they are likely to end up in a
nursing home afterward, new research from Johns Hopkins suggests.

“There has been this hunger to have some sort of scientific way to
predict surgical outcomes in older people,” Martin A. Makary, MD, MPH, an
associate professor of surgery at the Johns Hopkins University School of
Medicine and the study’s leader said in a press release. “We think we
have a way now to accurately measure risk instead of eyeballing somebody or

The key is a means of measuring frailty using a five-point scale,
developed at Johns Hopkins, Makary said. It includes loss of 10 pounds or more
within the previous year, weakness as measured by a handheld dynamometer,
exhaustion, low level of physical activity and slowed walking.

On the scale, one point is given for each problem. Scores of four or
five indicate that patients are considered frail; two or three indicate they
are considered intermediately frail. The test for frailty is simple to perform,
taking just 10 minutes to complete.

In a study reported online, Makary and his team applied the frailty test
to 594 patients older than 65 years who had elective surgery between July 2005
and July 2006. Results showed that patients who were frail were two and a half
times as likely as those who were not to suffer a postoperative complication,
one and a half times as likely to spend more time in the hospital and 20 times
as likely to be discharged to a nursing home or assisted living facility after
previously living at home.

Previous research has also linked frailty to poor outcomes even in
patients not undergoing surgery and has associated frailty with mortality,
morbidity, falls and increased hospitalization.

Surgeons have long known that some patients older than 65 years do quite
well after major surgery even though they appear feeble at the outset, while
others who seem to be healthier before an operation emerge diminished.
Predictive formulas based on cardiac health and medical history failed to stack
up well against the new frailty score, the researchers found.

Makary says frailty is a relatively new clinical concept and is best
defined as someone’s physical reserve and ability to withstand stress to
the body. Many patients considered medically healthy can be frail.

“Some surgeries are absolutely required no matter the risks and
other surgeries are elective,” Makary said. “A good frailty test can
help patients and surgeons make more informed decisions.”

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