Frailty Increases Mortality Risk After Surgery in Older Adults

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The risk for death 1 year after major surgery is significantly higher for frail patients.
The risk for death 1 year after major surgery is significantly higher for frail patients.

HealthDay News — Physical frailty among older patients who have elective surgery is linked to a greater risk of death 1 year later, according to a study published online Jan. 20 in JAMA Surgery.

Daniel I. McIsaac, MD, MPH, from the University of Ottawa in Canada, and colleagues assessed the physical frailty of 202 811 patients 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.

The researchers found that within a year after surgery, 13.6% of the frail patients died. In contrast, only 4.8% of those who weren't thought to be frail died during this postoperative time period. The risk for death 1 year after major surgery remained significantly higher for frail patients, even after adjustment for factors including age, gender, and income (adjusted hazard ratio, 2.23). Variables that affected a frail surgical patient's risk of death included time since surgery, age, and the type of surgery. Younger frail patients were also more at risk, as were those who had joint replacement 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," wrote the authors of an accompanying editorial.


1. McIsaac DI, Bryson GL, van Walraven C. Association of Frailty and 1-Year Postoperative Mortality Following Major Elective Noncardiac Surgery: A Population-Based Cohort Study. JAMA Surg. 2016; doi:10.1001/jamasurg.2015.5085.

2. Johanning JM, Hall D, Arya S. Frailty and Mortality After Noncardiac Surgery in Elderly Individuals: Metrics, Systems, and the Elephant. JAMA Surg. 2016; doi:10.1001/jamasurg.2015.5235.

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