Assessment of frailty can help surgeons predict perioperative risk and guide preoperative counseling, however current methods are often cumbersome in the clinical setting. The objective of this study is to prospectively compare the effectiveness of a rapid picture-based Clinical Frailty Scale (CFS-9) assessed by patient and surgeon against reference standard Fried Frailty Index (FFI) in older patients with pelvic floor conditions (PFC).
We enrolled 71 patients between 3/2018-6/2019. Frailty assessment using CFS-9 (scale ranging from "very fit" to "terminally ill") was performed followed by FFI, a validated tool of 5 measures (shrinking, physical energy, activity, grip strength, walking speed). Correlations and agreement between FFI and CFS-9 scores from the treating surgeon, a second surgeon (surgeon 2), and patient were analyzed using sensitivity, specificity, area under the curve (AUC), and Cohen's Kappa.
The patient cohort was mostly female (97.2%), had a mean age (±SD) of 73.0 (±5.9) years, and 23.9% were frail using FFI. Compared to FFI, CFS-9 scores of the treating surgeon, surgeon 2, and patient had AUC values (95% CI) of 0.86 (0.77-0.86), 0.91 (0.84-0.91), and 0.88 (0.79-0.88). As assessed by Cohen's Kappa, the CFS-9 scores all had substantial (Surgeon 2, Kappa = 0.66 (0.46,0.85) or moderate (all other CFS-9 measures, Kappa = 0.44 to 0.58) agreement with FFI scores.
Rapid and effective validated tools to screen for frailty are needed in the clinical setting. CFS-9 is an excellent predictor of frailty compared to FFI for patients with PFC.
The Journal of urology. 2020 Jan 02 [Epub ahead of print]
Katherine A Amin, Wai Lee, Dena Moskowitz, Kathleen C Kobashi, Alvaro Lucioni, May J Reed, Michael Nash, Una J Lee
Department of Urology, University of Miami Miller School of Medicine., Section of Urology and Renal Transplantation, Virginia Mason Medical Center., Department of Urology, University of California, Irvine., Division of Gerentology and Geriatric Medicine, Department of Medicine, University of Washington., Department of Statistics, University of Washington.