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A Rapid Method to Preoperatively Assess Frailty for Older Patients with Pelvic Floor Conditions.
J Urol. 2020 06; 203(6):1172-1177.JU

Abstract

PURPOSE

Assessment of frailty can help surgeons predict perioperative risk and guide preoperative counseling. However, current methods are often cumbersome in the clinical setting. We prospectively compared the effectiveness of a rapid picture based Clinical Frailty Scale (CFS-9) assessed by patient and surgeon against reference standard Fried Frailty Index in older patients with pelvic floor conditions.

MATERIALS AND METHODS

We enrolled 71 patients between March 2018 and June 2019. Frailty assessment using CFS-9 (scale ranging from very fit to terminally ill) was performed followed by the Fried Frailty Index, a validated tool of 5 measures (shrinking, physical energy, activity, grip strength, walking speed). Correlations and agreement between Fried Frailty Index and CFS-9 scores from the treating surgeon, a second surgeon (surgeon 2) and patient were analyzed using sensitivity, specificity, area under the curve and Cohen's Kappa.

RESULTS

The patient cohort was mostly female (97.2%), with a mean age (±SD) of 73.0 (±5.9) years and 23.9% were frail using the Fried Frailty Index. Compared to the Fried Frailty Index, 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), respectively. As assessed by Cohen's Kappa the CFS-9 scores all had substantial (surgeon 2, Kappa 0.66, 95% CI 0.46-0.85 or moderate (all other CFS-9 measures, Kappa 0.44 to 0.58) agreement with the Fried Frailty Index scores.

CONCLUSIONS

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 the Fried Frailty Index for patients with pelvic floor conditions.

Authors+Show Affiliations

Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.Department of Urology, University of California, Irvine, Irvine, California.Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.Division of Gerentology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington.Department of Statistics, University of Washington, Seattle, Washington.Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

31895003

Citation

Amin, Katherine A., et al. "A Rapid Method to Preoperatively Assess Frailty for Older Patients With Pelvic Floor Conditions." The Journal of Urology, vol. 203, no. 6, 2020, pp. 1172-1177.
Amin KA, Lee W, Moskowitz D, et al. A Rapid Method to Preoperatively Assess Frailty for Older Patients with Pelvic Floor Conditions. J Urol. 2020;203(6):1172-1177.
Amin, K. A., Lee, W., Moskowitz, D., Kobashi, K. C., Lucioni, A., Reed, M. J., Nash, M., & Lee, U. J. (2020). A Rapid Method to Preoperatively Assess Frailty for Older Patients with Pelvic Floor Conditions. The Journal of Urology, 203(6), 1172-1177. https://doi.org/10.1097/JU.0000000000000739
Amin KA, et al. A Rapid Method to Preoperatively Assess Frailty for Older Patients With Pelvic Floor Conditions. J Urol. 2020;203(6):1172-1177. PubMed PMID: 31895003.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Rapid Method to Preoperatively Assess Frailty for Older Patients with Pelvic Floor Conditions. AU - Amin,Katherine A, AU - Lee,Wai, AU - Moskowitz,Dena, AU - Kobashi,Kathleen C, AU - Lucioni,Alvaro, AU - Reed,May J, AU - Nash,Michael, AU - Lee,Una J, Y1 - 2020/01/02/ PY - 2020/1/3/pubmed PY - 2020/8/25/medline PY - 2020/1/3/entrez KW - frailty KW - operative KW - prolapse KW - surgical procedures KW - treatment outcome KW - urinary incontinence SP - 1172 EP - 1177 JF - The Journal of urology JO - J Urol VL - 203 IS - 6 N2 - PURPOSE: Assessment of frailty can help surgeons predict perioperative risk and guide preoperative counseling. However, current methods are often cumbersome in the clinical setting. We prospectively compared the effectiveness of a rapid picture based Clinical Frailty Scale (CFS-9) assessed by patient and surgeon against reference standard Fried Frailty Index in older patients with pelvic floor conditions. MATERIALS AND METHODS: We enrolled 71 patients between March 2018 and June 2019. Frailty assessment using CFS-9 (scale ranging from very fit to terminally ill) was performed followed by the Fried Frailty Index, a validated tool of 5 measures (shrinking, physical energy, activity, grip strength, walking speed). Correlations and agreement between Fried Frailty Index and CFS-9 scores from the treating surgeon, a second surgeon (surgeon 2) and patient were analyzed using sensitivity, specificity, area under the curve and Cohen's Kappa. RESULTS: The patient cohort was mostly female (97.2%), with a mean age (±SD) of 73.0 (±5.9) years and 23.9% were frail using the Fried Frailty Index. Compared to the Fried Frailty Index, 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), respectively. As assessed by Cohen's Kappa the CFS-9 scores all had substantial (surgeon 2, Kappa 0.66, 95% CI 0.46-0.85 or moderate (all other CFS-9 measures, Kappa 0.44 to 0.58) agreement with the Fried Frailty Index scores. CONCLUSIONS: 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 the Fried Frailty Index for patients with pelvic floor conditions. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/31895003/A_Rapid_Method_to_Preoperatively_Assess_Frailty_for_Older_Patients_with_Pelvic_Floor_Conditions_ L2 - https://www.jurology.com/doi/10.1097/JU.0000000000000739?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -