SUFU WM 2015 - Geriatrics Society Lecture: Assessing surgical risks in the elderly: what is ‘frailty’ and how should it impact your surgical practice?

SCOTTSDALE, AZ USA (UroToday.com) - There is no universal definition of frailty, which makes its assessment difficult. The commonly used metrics of age, as well as the American Society of Anesthesiology (ASA) score, correlate poorly to outcomes in the frail.

This is especially salient in urology patients as they tend to be older and have multiple medical comorbidities. Many pelvic floor procedures are considered for the impact on the patients quality-of-life and are often not lifesaving, the assessment of surgical risk/benefit is critical.

sufuDr. Gregory Bales reviewed various frailty assessment instruments. The MacArthur Study of Successful Aging (MSSA) looked at gait speed, handgrip strength, inactivity, and cognitive impairment metrics. These metrics taken in total correlated well with complications in patients undergoing cardiovascular procedures. The Fried Frailty Criteria, proposed by Fried and colleagues is defined as: unintentional >10 lbs. weight loss over a year, handgrip strength, low activity, slow walking speed, and exhaustion. This is currently the only instrument with data specifically assessing frailty in patients undergoing urologic surgery. The scoring system for the Fried Fraility Cristeria (FCC) is: 0-1 not frail, 2-3 intermediate, and 5 frail. Emory reported the utility of the FFC and demonstrated a 38.5% vs 11.9% complication rate in frail patients vs intermediate patients undergoing robot-assisted laparoscopic surgery. As part of their study, FFC outperformed ASA and ECOG in predictive value of complications.

Dr. Bales stressed the importance of assessing frailty syndrome and its correlation with complications when counseling patients regarding treatment options.

Presented by Gregory T. Bales, MD at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Winter Meeting - February 24 - 28, 2015 - JW Marriott Camelback Inn Resort & Spa - Scottsdale, AZ USA

The University of Chicago Medical Center, Chicago, IL USA

sufu freilich squareReported for UroToday by Drew Freilich, MD. Dr. Freilich is a graduate of the University of Massachusetts Medical School and completed his urology residency at New York Medical College/Westchester Medical Center. He is currently a fellow in Female Urology, Neurourology and Reconstructive Urology at Medical University of South Carolina. He has authored more than 40 peer-reviewed articles, monographs, abstracts, and book chapters and abstracts. Dr. Freilich is a member of the American Urological Association and the Society for Urodynamics and Female Urology.