Cognitive assessment helps predict survival in frail surgical patients

Editor's Note

Adding cognitive assessment to frailty assessment predicted poor postoperative outcomes and survival in frail patients better than either measurement alone, this study finds.

The study included 330 patients having major surgery who were assessed with a four-level composite frailty scoring system, which was created by combining the Fried Frailty score and Emory clock draw test to assess preoperative frailty and cognitive impairment.

Multivariate analysis showed the physically frail and cognitively impaired had a 3.92 higher risk of death. Kaplan-Meier survival curves revealed an overall difference in long-term survival driven mainly by the high risk of mortality in patients with both physical frailty and cognitive impairment.

The addition of cognitive assessment to physical frailty measurement can improve preoperative decision making and early intervention plus more accurate patient counseling, the authors say.

The definition of frailty, as modeled by the Fried criteria, has been limited primarily to the physical domain. The purpose of this study was to assess 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.