Frailty: An outcome predictor for elderly gynecologic oncology patients

ObjectivesThe objective of this pilot study was to determine if frailty predicts surgical complications among elderly women undergoing gynecologic oncology procedures.MethodsA cohort of gynecologic oncology patients age ≥ 65, undergoing surgery between March and December 2011 was identified. Frailty was evaluated using a validated assessment tool. The primary outcome measure was 30 day postoperative complication rate.ResultsForty women were approached for study entry and 37 (92%) enrolled. The mean age was 73 years (range 65–95). The majority of women had a malignancy and underwent a major abdominal surgical procedure. Twenty-one women (57%) were not frail, 10 (27%) were intermediately frail and 6 (16%) were frail. There was no difference in age or prevalence of medical comorbidities between groups. Frail women had a significantly higher BMI compared to intermediately frail and not frail women, (36.0, 31.5 and 26.1 kg/m2, p = 0.02). The rate of 30-day surgical complications increased with frailty score and was 24%, versus 67% for women who were not frail as compared to the frail (p = 0.04).ConclusionsPre-operative frailty assessment is well accepted by gynecologic oncology patients and feasible in a clinic setting. Frail women had a higher BMI, indicating that low body weight is not a marker for frailty, and had a significantly higher rate of 30-day postoperative complications in this pilot study. Initial findings support the concept of measuring frailty as a possible predictor for postoperative morbidity that will allow for improved patient counseling and decision making.

► Forty-three percent of patients 65 or older are frail or intermediately frail.
► Low body weight is not a marker for frailty.
► Elderly frail patients are at increased risk for post-operative complications.