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Prevalence of frailty and reliability of established frailty instruments in adult elective colorectal surgical patients: a prospective cohort study
  1. Thomas Dale MacLaine1,
  2. Oliver Baker2,
  3. Dermot Burke2,
  4. Simon J Howell2
  1. 1 Warwick Medical School, University of Warwick, Coventry, UK
  2. 2 Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
  1. Correspondence to Dr Thomas Dale MacLaine, Medical School, University of Warwick Warwick Medical School, Coventry, Coventry, UK; thomas.dale-maclaine{at}


Purpose Large population studies now demonstrate that frailty is prevalent in all adult age groups. Limited data exist on the association between frailty and surgical outcome in younger patients. The aim of the study was to explore the agreement between frailty identification tools and collect pilot data on their predictive value for frailty-associated outcomes in an adult surgical population.

Study design Prospective cohort study.

Results Frailty scores were recorded in 200 patients (91 men), mean (range) age 57 (18–92) years. The prevalence of prefrailty was 52%–67% and that of frailty 2%–32% depending on the instrument used. Agreement between the instruments was poor, kappa 0.08–0.17 in pairwise comparisons. Outcome data were available on 160 patients. Only the frailty phenotype was significantly associated with adverse outcomes, RR 6.1 (1.5–24.5) for postoperative complications. The three frailty scoring instruments studies had good sensitivity (Clinical Frailty Scale (CFS)—90%, Accumulation Deficit (AD)—96%, Frailty Phenotype (FP)—97%) but poor specificity (CFS—12%, AD—13%, FP—18%) for the prediction of postoperative complications. All three instruments were poorly predictive of adverse outcomes with likelihood ratios of CFS—1.02, AD—1.09 and FP—1.17.

Conclusions This study showed a significant prevalence of prefrailty and frailty in adult colorectal surgical patients of all ages. There was poor agreement between three established frailty scoring instruments. Our data do not support the use of current frailty scoring instruments in all adult colorectal surgical patients. However, the significant prevalence of prefrailty and frailty across all age groups of adult surgical patient justifies further research to refine frailty scoring in surgical patients.

  • colorectal surgery
  • geriatric medicine
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  • Contributors TDM, DB and SH designed the research study. TDM and OB collected research data. TDM analysed the data. All authors contributed to the production and editing of the manuscript.

  • Funding This study was supported by a grant from the British Journal of Anaesthesia/Royal College of Anaesthetists.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was received from the West Midlands Edgbaston UK Research Ethics Committee (15/WM/0148). Informed written consent was obtained from all participants, and were all deemed to have capacity my healthcare.

  • Data availability statement Data are available upon reasonable request. We follow ICMJE’s example 3:, deidentified, is held. Study protocol is available. Data will be available between 9 months beginning and 36 months ending following publication. Data can be shared when proposition has approval from independent review committees. Meta-analyses from these data will be permitted. Proposals may be submitted up to 36 months following publication, to the corresponding author.

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