Makhani SS, et al. – Researchers performed this work to determine the additive value of cognitive function with existing frailty criteria to predict poor postoperative outcomes in a large multidisciplinary cohort of patients undergoing major surgery. As per observations, the use of a combined frailty and cognitive assessment score proved to have powerful potential to predict adult patients at higher risk of overall survival, than either measurement alone. The addition of cognitive assessment to physical frailty measure could improve preoperative decision making and possibly early intervention, as well as more accurate patient counseling.

Methods

• Researchers created a four-level composite frailty scoring system via the combination of the Fried Frailty score and the Emory clock draw test to assess preoperative frailty and cognitive impairment, respectively.
• They defined overall survival outcome as months from date of surgery to date of death or last follow-up.

Results

• 330 patients undergoing major surgery were included; mean age was 58 years; 53 patient died over a four year follow-up.
• Among the robust cohort, 20 out of 168 patients died (11.9%), and among those who were both physically frail and cognitively impaired, 11 out of 26 patients died (42.3%).
• On the basis of multivariable analysis, it was established that the physically frail and cognitively impaired cohort have a 3.92 higher risk of death (CI 1.66 - 9.26) compared to the cohort of robust patients (p = 0.002).
• In this study, Kaplan-Meier survival curves revealed an overall difference in long-term survival (log-rank p < 0.0001), driven mainly by the high risk of mortality among patients with both physical frailty and cognitive impairment.