The perioperative impact of frailty and cognitive impairment in older surgical patients: A multicentered longitudinal cohort study

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INTRODUCTION: Frailty and cognitive impairment (CI) are prevalent conditions that often co-exist in older patients and lead to worse perioperative outcomes. Despite this, these conditions are not routinely assessed preoperatively, and their impact and interactions during the perioperative period remain poorly understood. Using ultra-rapid screening tools, this study aimed to (1) compare the perioperative prevalence and trajectory of frailty between patients with and without CI and (2) investigate patient-reported outcome measures and clinical outcomes associated with preoperative frailty and CI. METHODS: This multicentered longitudinal cohort study assessed CI and frailty in 370 older non-cardiac surgical patients using ultra-rapid screening tools: the Ascertain Dementia Eight-item Questionnaire (AD8) (cutoff: ≥2) and 5-item FRAIL Questionnaire (prefrail: 1-2; frail: ≥3). The trajectories of frailty in CI versus no-CI patients were analyzed using a linear mixed-effects model. Univariable and multivariable logistic regressions were conducted to identify risk factors associated with preoperative frailty. MAIN RESULTS: Up to 63% of older surgical patients experienced preoperative prefrailty (48%) or frailty (15%). Eighty-one percent of patients with preoperative CI were preoperatively prefrail (49%) or frail (32%). Patients with CI were more frail at all postoperative time points than no-CI patients. Patients classified as prefrail/frail preoperatively had longer length of stay, greater incidence of non-home discharge, and composite outcomes at 30 days than robust patients. Patients with combined prefrailty/frailty and CI experienced significantly worse 90-day composite outcomes than those with prefrailty/frailty alone. In the multivariable analysis, females (3-fold), orthopedic surgery (7-fold), significant preoperative functional disability (6-fold), and high risk of obstructive sleep apnea (5-fold) were significantly associated with preoperative frailty. CONCLUSIONS: Patients with preoperative CI were significantly more frail at all perioperative time points than those without. While preoperative prefrailty/frailty was associated with significantly worse 30-day outcomes, only patients with combined prefrailty/frailty and CI experienced worse long-term outcomes at 90 days.

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