Fagard Katleen, Geyskens Lisa, Van den Bogaert Björk, Willems Sarah, Flamaing Johan, Wolthuis Albert, Deschodt Mieke
Department of Geriatric Medicine, University Hospital Leuven, Leuven, Belgium.
Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
J Am Geriatr Soc. 2025 Apr;73(4):1060-1072. doi: 10.1111/jgs.19317. Epub 2024 Dec 29.
Frailty screening instruments are increasingly studied as risk predictors for adverse postoperative outcomes. However, because of the lack of comparative research, it is unclear which screening instrument performs best. This study therefore compared the diagnostic accuracy of seven frailty screening instruments for adverse postoperative outcomes in patients aged ≥70 years undergoing colorectal surgery.
We conducted a prospective cohort study at an academic hospital, examining the Fried and Robinson frailty criteria, the Edmonton Frail Scale, the Rockwood Clinical Frailty Scale, the Modified Frailty Index, the FRAIL questionnaire, and the Geriatric 8 for predicting postoperative complications with a Clavien-Dindo (CD) severity grade ≥2. Secondary outcomes were complications with CD severity grade ≥3, prolonged length of stay, increased care level after discharge, and functional decline in basic or instrumental activities of daily living up to 1 month after surgery.
The study included 172 consecutive patients. Positive frailty screening ranged from 13.4% to 73.8%. CD≥2 complications were present in 37.8% of patients. At the original cutoffs, most instruments had a high specificity (76.7%-92.4%) at the expense of sensitivity (21.5%-38.5%) with a moderate negative predictive value (NPV) for predicting CD≥2 complications. The Geriatric 8 showed the opposite pattern (sensitivity 81.5%-specificity 30.8%) and a high NPV. Diagnostic accuracy was moderate for all screening instruments, since the areas under the receiver operating characteristic curve did not exceed 0.61 across instruments. Altering the cutoff scores did not yield sufficient improvement. Comparable results were found for the secondary outcomes.
Comparing the predictive value of the screening instruments showed that frailty screening cannot be used in isolation as risk predictor for adverse postoperative outcomes. Further research should focus on a two-step approach in which additional diagnosis of frailty by means of comprehensive geriatric assessment is included in the prediction model.
衰弱筛查工具作为术后不良结局的风险预测指标正受到越来越多的研究。然而，由于缺乏比较研究，尚不清楚哪种筛查工具表现最佳。因此，本研究比较了七种衰弱筛查工具对年龄≥70岁接受结直肠手术患者术后不良结局的诊断准确性。
我们在一家学术医院进行了一项前瞻性队列研究，采用弗里德和罗宾逊衰弱标准、埃德蒙顿衰弱量表、罗克伍德临床衰弱量表、改良衰弱指数、衰弱问卷和老年8项指标来预测Clavien-Dindo（CD）严重程度分级≥2的术后并发症。次要结局包括CD严重程度分级≥3的并发症、住院时间延长、出院后护理级别提高以及术后1个月内基本或工具性日常生活活动中的功能下降。
该研究纳入了172例连续患者。阳性衰弱筛查率在13.4%至73.8%之间。37.8%的患者出现CD≥2级并发症。在原始临界值时，大多数工具具有较高的特异性（76.7% - 92.4%），但以敏感性（21.5% - 38.5%）为代价，对预测CD≥2级并发症的阴性预测值（NPV）中等。老年8项指标表现出相反的模式（敏感性81.5% - 特异性30.8%）且NPV较高。所有筛查工具的诊断准确性中等，因为各工具的受试者工作特征曲线下面积均未超过0.61。改变临界值分数并未带来足够的改善。次要结局的结果类似。
比较筛查工具的预测价值表明，衰弱筛查不能单独用作术后不良结局的风险预测指标。进一步的研究应侧重于两步法，即在预测模型中纳入通过综合老年评估对衰弱进行的额外诊断。
