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Rapid Methods for Routine Frailty Assessment during Vascular Surgery Clinic Visits.
Ann Vasc Surg. 2018 Jan; 46:134-141.AV

Abstract

BACKGROUND

Frailty assessment can help vascular surgeons predict perioperative risk and long-term mortality for their patients. Unfortunately, comprehensive frailty assessments take too long to integrate into clinic workflow. This study was designed to evaluate 2 rapid methods for assessing frailty during vascular clinics-a short patient-reported survey and a provider-reported frailty scale.

METHODS

We prospectively enrolled 159 patients presenting to an academic medical center vascular surgery clinic between May and November 2016. Patients underwent frailty assessment using 2 rapid methods: (1) the Frail Nondisabled (FiND) survey (5 questions) and (2) the Clinical Frailty Scale (CFS; 9-point scale from robust to severely frail). These were followed by administering the Fried Index, a validated frailty assessment method with 5 measures (weight loss, exhaustion, grip strength, walking speed, and activity level). The correlation between Fried scores (reference standard) with frailty diagnoses derived from FiND and CFS was analyzed using the Spearman-rank test, Cohen's kappa, sensitivity/specificity tests, and receiver operating curves.

RESULTS

The evaluated cohort included 87 (55%) females, a mean age of 61 years, 126 (79%) preoperative patients, and 32 (20%) categorized as frail using the Fried Index criteria. The FiND survey was very sensitive (91%) but less specific for diagnosing frailty. In comparison, the CFS was highly specific (96%) for diagnosing frailty and exhibited high inter-rater reliability between surgeon and medical assistant scores (kappa: 0.79; 95% CI: 0.72-0.87; P < 0.001). There was moderate correlation between frailty assigned using the Fried Index and the CFS (rho: 0.41-0.44).

CONCLUSIONS

Frailty can be quickly and effectively assessed during vascular surgery clinic using a combination of patient-reported (FiND) and provider-reported (CFS) methods to improve diagnostic accuracy. Implementing routine frailty assessment into clinic workflow can be a valuable tool for risk prediction and surgical decision-making.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT. Electronic address: benjamin.brooke@hsc.utah.edu.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28887242

Citation

Mirabelli, Luke G., et al. "Rapid Methods for Routine Frailty Assessment During Vascular Surgery Clinic Visits." Annals of Vascular Surgery, vol. 46, 2018, pp. 134-141.
Mirabelli LG, Cosker RM, Kraiss LW, et al. Rapid Methods for Routine Frailty Assessment during Vascular Surgery Clinic Visits. Ann Vasc Surg. 2018;46:134-141.
Mirabelli, L. G., Cosker, R. M., Kraiss, L. W., Griffin, C. L., Smith, B. K., Sarfati, M. R., Al-Dulaimi, R., & Brooke, B. S. (2018). Rapid Methods for Routine Frailty Assessment during Vascular Surgery Clinic Visits. Annals of Vascular Surgery, 46, 134-141. https://doi.org/10.1016/j.avsg.2017.08.010
Mirabelli LG, et al. Rapid Methods for Routine Frailty Assessment During Vascular Surgery Clinic Visits. Ann Vasc Surg. 2018;46:134-141. PubMed PMID: 28887242.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid Methods for Routine Frailty Assessment during Vascular Surgery Clinic Visits. AU - Mirabelli,Luke G, AU - Cosker,Robert M, AU - Kraiss,Larry W, AU - Griffin,Claire L, AU - Smith,Brigitte K, AU - Sarfati,Mark R, AU - Al-Dulaimi,Ragheed, AU - Brooke,Benjamin S, Y1 - 2017/09/06/ PY - 2017/03/21/received PY - 2017/07/30/revised PY - 2017/08/02/accepted PY - 2017/9/10/pubmed PY - 2018/7/26/medline PY - 2017/9/10/entrez SP - 134 EP - 141 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 46 N2 - BACKGROUND: Frailty assessment can help vascular surgeons predict perioperative risk and long-term mortality for their patients. Unfortunately, comprehensive frailty assessments take too long to integrate into clinic workflow. This study was designed to evaluate 2 rapid methods for assessing frailty during vascular clinics-a short patient-reported survey and a provider-reported frailty scale. METHODS: We prospectively enrolled 159 patients presenting to an academic medical center vascular surgery clinic between May and November 2016. Patients underwent frailty assessment using 2 rapid methods: (1) the Frail Nondisabled (FiND) survey (5 questions) and (2) the Clinical Frailty Scale (CFS; 9-point scale from robust to severely frail). These were followed by administering the Fried Index, a validated frailty assessment method with 5 measures (weight loss, exhaustion, grip strength, walking speed, and activity level). The correlation between Fried scores (reference standard) with frailty diagnoses derived from FiND and CFS was analyzed using the Spearman-rank test, Cohen's kappa, sensitivity/specificity tests, and receiver operating curves. RESULTS: The evaluated cohort included 87 (55%) females, a mean age of 61 years, 126 (79%) preoperative patients, and 32 (20%) categorized as frail using the Fried Index criteria. The FiND survey was very sensitive (91%) but less specific for diagnosing frailty. In comparison, the CFS was highly specific (96%) for diagnosing frailty and exhibited high inter-rater reliability between surgeon and medical assistant scores (kappa: 0.79; 95% CI: 0.72-0.87; P < 0.001). There was moderate correlation between frailty assigned using the Fried Index and the CFS (rho: 0.41-0.44). CONCLUSIONS: Frailty can be quickly and effectively assessed during vascular surgery clinic using a combination of patient-reported (FiND) and provider-reported (CFS) methods to improve diagnostic accuracy. Implementing routine frailty assessment into clinic workflow can be a valuable tool for risk prediction and surgical decision-making. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/28887242/Rapid_Methods_for_Routine_Frailty_Assessment_during_Vascular_Surgery_Clinic_Visits_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(17)30950-0 DB - PRIME DP - Unbound Medicine ER -