Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study

Daniel I. McIsaac; Monica Taljaard; Gregory L. Bryson; Paul E. Beaulé; Sylvain Gagne; Gavin Hamilton; Emily Hladkowicz; Allen Huang; John Joanisse; Luke T. Lavallée; David MacDonald; Husein Moloo; Kednapa Thavorn; Carl van Walraven; Homer Yang; Alan J. Forster

doi:10.1016/j.bja.2020.07.003

Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study

Daniel I. McIsaac, Monica Taljaard, Gregory L. Bryson, Paul E. Beaulé, Sylvain Gagne, Gavin Hamilton, Emily Hladkowicz, Allen Huang, John Joanisse, Luke T. Lavallée, David MacDonald, Husein Moloo, Kednapa Thavorn, Carl van Walraven, Homer Yang, Alan J. Forster

Medicine

Research output: Contribution to journal › Article › peer-review

47 Citations (Scopus)

Abstract

Background: Frailty is associated with early postoperative outcomes. How frailty influences long-term postoperative recovery is poorly described. Our objective was to evaluate the association of frailty with postoperative disability trajectories in the year after surgery. Methods: Prespecified 1-yr follow-up of a prospective multicentre cohort study. Patients ≥65 yr were assessed for frailty before major elective noncardiac surgery (Clinical Frailty Scale [CFS] and Fried Phenotype [FP]). The primary outcome was patient-reported disability score (using the WHO Disability Assessment Schedule 2.0) at baseline, 30, 90, and 365 days after surgery. Repeated measures linear regression estimated the association of preoperative frailty with changes in disability scores over time, adjusted for procedure. Group-based trajectory modelling was used to identify subgroup trajectories of people with frailty. Results: One-year follow-up was complete for 687/702 (97.9%) participants. Frailty was associated with a significant difference in disability trajectory (P<0.0001). Compared with baseline, people with frailty experienced a decrease in disability score at 365 days (CFS frailty: −7.3 points, 95% confidence interval [CI] −10.2 to −4.5); (FP frailty: −5.4 points, 95% CI −8.5 to −2.3); people without frailty had no significant change in their disability score from baseline (no CFS frailty: +0.8 points, 95% CI −1.7 to 3.2; no FP frailty: +1.1 points, 95% CI −3.5 to 1.3). More than one-third of people with frailty experienced an early increase in disability before achieving a net decrease in disability. Conclusions: Decision-making and care planning should integrate the possible trade-offs between early adverse outcomes with longer-term benefit when frailty is present in older surgical patients.

Original language	English
Pages (from-to)	704-711
Number of pages	8
Journal	British Journal of Anaesthesia
Volume	125
Issue number	5
DOIs	https://doi.org/10.1016/j.bja.2020.07.003
Publication status	Published - Nov 2020

Bibliographical note

Funding Information:
PEB reports personal fees from Corin, personal fees from MicroPort, personal fees from Zimmer Biomet, personal fees from Medacta, personal fees from MatOrtho, grants from Zimmer Biomet, outside the submitted work. LTL reports grants and personal fees from Sanofi, personal fees from Ferring, outside the submitted work. The remaining authors declare that they have no conflicts of interest.The Canadian Frailty Network and The Ottawa Hospital Academic Medical Organization through peer-reviewed grants. Funders played no role in design, execution or reporting. DIM was supported by the Canadian Anesthesiologist's Society Career Scientist Award, the University of Ottawa's Junior Clinical Research Chair Award and salary support from The Ottawa Hospital Anesthesiology Alternate Funds Association.

Funding Information:
PEB reports personal fees from Corin , personal fees from MicroPort , personal fees from Zimmer Biomet , personal fees from Medacta , personal fees from MatOrtho , grants from Zimmer Biomet , outside the submitted work. LTL reports grants and personal fees from Sanofi , personal fees from Ferring , outside the submitted work. The remaining authors declare that they have no conflicts of interest.

Publisher Copyright:
© 2020 British Journal of Anaesthesia

ASJC Scopus Subject Areas

Anesthesiology and Pain Medicine

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10.1016/j.bja.2020.07.003

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McIsaac, D. I., Taljaard, M., Bryson, G. L., Beaulé, P. E., Gagne, S., Hamilton, G., Hladkowicz, E., Huang, A., Joanisse, J., Lavallée, L. T., MacDonald, D., Moloo, H., Thavorn, K., van Walraven, C., Yang, H., & Forster, A. J. (2020). Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study. British Journal of Anaesthesia, 125(5), 704-711. https://doi.org/10.1016/j.bja.2020.07.003

McIsaac, DI, Taljaard, M, Bryson, GL, Beaulé, PE, Gagne, S, Hamilton, G, Hladkowicz, E, Huang, A, Joanisse, J, Lavallée, LT, MacDonald, D, Moloo, H, Thavorn, K, van Walraven, C, Yang, H & Forster, AJ 2020, 'Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study', British Journal of Anaesthesia, vol. 125, no. 5, pp. 704-711. https://doi.org/10.1016/j.bja.2020.07.003

@article{75f5091442e741c6bf6e7462dc89142c,

title = "Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study",

abstract = "Background: Frailty is associated with early postoperative outcomes. How frailty influences long-term postoperative recovery is poorly described. Our objective was to evaluate the association of frailty with postoperative disability trajectories in the year after surgery. Methods: Prespecified 1-yr follow-up of a prospective multicentre cohort study. Patients ≥65 yr were assessed for frailty before major elective noncardiac surgery (Clinical Frailty Scale [CFS] and Fried Phenotype [FP]). The primary outcome was patient-reported disability score (using the WHO Disability Assessment Schedule 2.0) at baseline, 30, 90, and 365 days after surgery. Repeated measures linear regression estimated the association of preoperative frailty with changes in disability scores over time, adjusted for procedure. Group-based trajectory modelling was used to identify subgroup trajectories of people with frailty. Results: One-year follow-up was complete for 687/702 (97.9%) participants. Frailty was associated with a significant difference in disability trajectory (P<0.0001). Compared with baseline, people with frailty experienced a decrease in disability score at 365 days (CFS frailty: −7.3 points, 95% confidence interval [CI] −10.2 to −4.5); (FP frailty: −5.4 points, 95% CI −8.5 to −2.3); people without frailty had no significant change in their disability score from baseline (no CFS frailty: +0.8 points, 95% CI −1.7 to 3.2; no FP frailty: +1.1 points, 95% CI −3.5 to 1.3). More than one-third of people with frailty experienced an early increase in disability before achieving a net decrease in disability. Conclusions: Decision-making and care planning should integrate the possible trade-offs between early adverse outcomes with longer-term benefit when frailty is present in older surgical patients.",

author = "McIsaac, {Daniel I.} and Monica Taljaard and Bryson, {Gregory L.} and Beaul{\'e}, {Paul E.} and Sylvain Gagne and Gavin Hamilton and Emily Hladkowicz and Allen Huang and John Joanisse and Lavall{\'e}e, {Luke T.} and David MacDonald and Husein Moloo and Kednapa Thavorn and {van Walraven}, Carl and Homer Yang and Forster, {Alan J.}",

note = "Funding Information: PEB reports personal fees from Corin, personal fees from MicroPort, personal fees from Zimmer Biomet, personal fees from Medacta, personal fees from MatOrtho, grants from Zimmer Biomet, outside the submitted work. LTL reports grants and personal fees from Sanofi, personal fees from Ferring, outside the submitted work. The remaining authors declare that they have no conflicts of interest.The Canadian Frailty Network and The Ottawa Hospital Academic Medical Organization through peer-reviewed grants. Funders played no role in design, execution or reporting. DIM was supported by the Canadian Anesthesiologist's Society Career Scientist Award, the University of Ottawa's Junior Clinical Research Chair Award and salary support from The Ottawa Hospital Anesthesiology Alternate Funds Association. Funding Information: PEB reports personal fees from Corin , personal fees from MicroPort , personal fees from Zimmer Biomet , personal fees from Medacta , personal fees from MatOrtho , grants from Zimmer Biomet , outside the submitted work. LTL reports grants and personal fees from Sanofi , personal fees from Ferring , outside the submitted work. The remaining authors declare that they have no conflicts of interest. Publisher Copyright: {\textcopyright} 2020 British Journal of Anaesthesia",

year = "2020",

month = nov,

doi = "10.1016/j.bja.2020.07.003",

language = "English",

volume = "125",

pages = "704--711",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Oxford University Press",

number = "5",

}

TY - JOUR

T1 - Frailty and long-term postoperative disability trajectories

T2 - a prospective multicentre cohort study

AU - McIsaac, Daniel I.

AU - Taljaard, Monica

AU - Bryson, Gregory L.

AU - Beaulé, Paul E.

AU - Gagne, Sylvain

AU - Hamilton, Gavin

AU - Hladkowicz, Emily

AU - Huang, Allen

AU - Joanisse, John

AU - Lavallée, Luke T.

AU - MacDonald, David

AU - Moloo, Husein

AU - Thavorn, Kednapa

AU - van Walraven, Carl

AU - Yang, Homer

AU - Forster, Alan J.

N1 - Funding Information: PEB reports personal fees from Corin, personal fees from MicroPort, personal fees from Zimmer Biomet, personal fees from Medacta, personal fees from MatOrtho, grants from Zimmer Biomet, outside the submitted work. LTL reports grants and personal fees from Sanofi, personal fees from Ferring, outside the submitted work. The remaining authors declare that they have no conflicts of interest.The Canadian Frailty Network and The Ottawa Hospital Academic Medical Organization through peer-reviewed grants. Funders played no role in design, execution or reporting. DIM was supported by the Canadian Anesthesiologist's Society Career Scientist Award, the University of Ottawa's Junior Clinical Research Chair Award and salary support from The Ottawa Hospital Anesthesiology Alternate Funds Association. Funding Information: PEB reports personal fees from Corin , personal fees from MicroPort , personal fees from Zimmer Biomet , personal fees from Medacta , personal fees from MatOrtho , grants from Zimmer Biomet , outside the submitted work. LTL reports grants and personal fees from Sanofi , personal fees from Ferring , outside the submitted work. The remaining authors declare that they have no conflicts of interest. Publisher Copyright: © 2020 British Journal of Anaesthesia

PY - 2020/11

Y1 - 2020/11

N2 - Background: Frailty is associated with early postoperative outcomes. How frailty influences long-term postoperative recovery is poorly described. Our objective was to evaluate the association of frailty with postoperative disability trajectories in the year after surgery. Methods: Prespecified 1-yr follow-up of a prospective multicentre cohort study. Patients ≥65 yr were assessed for frailty before major elective noncardiac surgery (Clinical Frailty Scale [CFS] and Fried Phenotype [FP]). The primary outcome was patient-reported disability score (using the WHO Disability Assessment Schedule 2.0) at baseline, 30, 90, and 365 days after surgery. Repeated measures linear regression estimated the association of preoperative frailty with changes in disability scores over time, adjusted for procedure. Group-based trajectory modelling was used to identify subgroup trajectories of people with frailty. Results: One-year follow-up was complete for 687/702 (97.9%) participants. Frailty was associated with a significant difference in disability trajectory (P<0.0001). Compared with baseline, people with frailty experienced a decrease in disability score at 365 days (CFS frailty: −7.3 points, 95% confidence interval [CI] −10.2 to −4.5); (FP frailty: −5.4 points, 95% CI −8.5 to −2.3); people without frailty had no significant change in their disability score from baseline (no CFS frailty: +0.8 points, 95% CI −1.7 to 3.2; no FP frailty: +1.1 points, 95% CI −3.5 to 1.3). More than one-third of people with frailty experienced an early increase in disability before achieving a net decrease in disability. Conclusions: Decision-making and care planning should integrate the possible trade-offs between early adverse outcomes with longer-term benefit when frailty is present in older surgical patients.

AB - Background: Frailty is associated with early postoperative outcomes. How frailty influences long-term postoperative recovery is poorly described. Our objective was to evaluate the association of frailty with postoperative disability trajectories in the year after surgery. Methods: Prespecified 1-yr follow-up of a prospective multicentre cohort study. Patients ≥65 yr were assessed for frailty before major elective noncardiac surgery (Clinical Frailty Scale [CFS] and Fried Phenotype [FP]). The primary outcome was patient-reported disability score (using the WHO Disability Assessment Schedule 2.0) at baseline, 30, 90, and 365 days after surgery. Repeated measures linear regression estimated the association of preoperative frailty with changes in disability scores over time, adjusted for procedure. Group-based trajectory modelling was used to identify subgroup trajectories of people with frailty. Results: One-year follow-up was complete for 687/702 (97.9%) participants. Frailty was associated with a significant difference in disability trajectory (P<0.0001). Compared with baseline, people with frailty experienced a decrease in disability score at 365 days (CFS frailty: −7.3 points, 95% confidence interval [CI] −10.2 to −4.5); (FP frailty: −5.4 points, 95% CI −8.5 to −2.3); people without frailty had no significant change in their disability score from baseline (no CFS frailty: +0.8 points, 95% CI −1.7 to 3.2; no FP frailty: +1.1 points, 95% CI −3.5 to 1.3). More than one-third of people with frailty experienced an early increase in disability before achieving a net decrease in disability. Conclusions: Decision-making and care planning should integrate the possible trade-offs between early adverse outcomes with longer-term benefit when frailty is present in older surgical patients.

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Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study

Abstract

Bibliographical note

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