Physical frailty among older people who have elective surgery is linked to a greater risk of death one year later, a new study suggests.
Canadian researchers found the one-year death rate for frail older patients having certain surgeries was at least one death for every five people. To make informed treatment decision, doctors, patients and their families should be aware of this heightened risk, the team advised.
“While the choice to proceed with an elective surgery must be weighed on a case-by-case basis, our findings support the need for thorough considerations of risk vs. benefit and the overall goals of care in frail patients considering major surgery,” study leader Dr. Daniel McIsaac, of the University of Ottawa in Ontario, and colleagues wrote.
“Our findings suggest specific areas of focus for clinical and research efforts aimed at improving the care and outcomes of frail elderly surgical patients,” the researchers said.
Although the study found a link between frailty and the risk of death, it’s important to note that the study could not show a cause-and-effect relationship.
The researchers assessed the physical frailty of more than 200,000 people who were aged 65 and older. The average age was 77. They all underwent elective major non-cardiac surgery, such as large bowel surgery, joint replacement and liver resection. Three percent were considered frail, according to the researchers.
Within a year after surgery, 14 percent of the frail patients died. In contrast, only 5 percent of those who weren’t thought to be frail died during this postoperative time period. The risk for death one year after major surgery remained significantly higher for frail patients, even after the researchers took other factors into account, such as the patients’ age, gender and income.
Variables that affected a frail surgical patient’s risk of death included time since surgery, age and the type of surgery. The risk of dying was highest earliest in the postoperative period for frail patients, the study found. Younger frail patients were also more at risk, as were those who had joint replacement surgery, the study revealed.
The study was published online Jan. 20 in the journal JAMA Surgery.
“With this rigorous population-based, retrospective cohort study of surgical patients in Ontario, Canada, McIsaac and colleagues add to the growing literature demonstrating markedly increased risks frailty imposes on surgical populations,” Dr. Jason Johanning and his colleagues, from the Nebraska Western Iowa VA Medical Center in Omaha, wrote in an accompanying editorial.
“Regardless of how frailty is measured, it still paints a picture of the same elephant: dramatically increased risks for postoperative mortality and morbidity. The elephant is now in our examination room and we, as surgeons, must address the optimal goals of care and honor patients’ preferences,” they wrote.
The U.S. National Institute on Aging provides more information for older people considering surgery.