New Frailty Test Could Improve Surgical Outcomes, Reduce Cost Discrepancies

Cheryl Clark, for HealthLeaders Media , May 13, 2010

"We found that this scoring system was highly predictive," he says. And it's critically important that such an evaluation tool be standardized for older people because half of all operations in the U.S. are performed in patients older than 65.

Makary and colleagues wrote that use of a frailty tool "might help explain why some older patients recover better than expected and others fare worse than expected."

They wrote: "A fundamental tenet of geriatric medicine is that standard indications for medical interventions might not be generalizable to older patients because physiologic changes from aging, potentially exacerbated by multiple morbidities, can alter the risk-to-benefit analysis."

Additionally, patients who are judged too frail for the risks of surgery may have options. Some "can benefit from interventions to reduce risk, such as preoperative conditioning, nutrition or even pharmacological therapy," the authors wrote.

Makary pointed out that today physicians may use other scoring systems that rank "reserve thresholds" for various organs. For example, they might say that a person has a strong or a weak kidney reserve, heart strength reserve, muscle mass reserve or, for people with dementia, a "psychological" reserve.

"We think they are all related, and when one system fails it affects the others and starts a vicious cycle," says Makary. The frailty scoring system he and his colleagues developed, takes all of those reserve systems into account.

The frailty test, the researchers wrote, "strengthened the predictive ability of other commonly used" tests that attempt to determine morbidity risk of surgical candidates.

Makary's study has several shortcomings. The trial only looked at 30-day outcomes and did not look at quality of life. The participants were patients at an academic medical center, where results of trials don't always translate to community practice.

The study received financial support from the National Institutes of Health, and several nonprofit foundations and organizations.

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