Frailty has gained recognition as an objective measure of a patient's physiologic reserve that ideally can replace the subjective biases of surgeons. In this study, we sought to examine the concordance between patient and attending surgeon perceptions of the patient's “fitness” before surgery. We then correlated these ratings with the patient's objective frailty scores.
Patients were prospectively enrolled from urology, general surgery, and surgical oncology clinics. Patients were asked to rate their ability to withstand the physical stress of the scheduled surgery on a visual analog scale. The operating surgeon then independently rated his assessment of the patient's ability to withstand surgery blinded to the patient's self assessment.
A total of 203 patients were included. Median patient age and body mass index were 62 (range = 21–87) years and 28.1 kg/m2 (18.0–53.1), respectively. The majority of patients were white (67%) and male (60.6%). A patients' self-assessment showed no correlation with their age; however, surgeons' ratings showed a positive correlation with patients' age. Patients' self-rated scores showed a positive correlation with their frailty score, although surgeons' ratings showed a stronger correlation. However, when stratified by age group, the positive correlation and predictive ability were lost (P value = 0.198).
Although age is an established risk factor, our data demonstrate surgeons may place an overreliance on a patient's age in place of an objective measure of physiologic reserve. Conversely, patients tended to overestimate their ability to withstand the stress of surgery, possibly leading to unrealistic expectations of their recovery and outcomes.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Surgical Research
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Presentation of multivariate data for clinical use: the Framingham study risk score functions.Stat Med. 2004; 23: 1631
- Risk scoring in surgical patients.Br J Surg. 1999; 86: 149
- Redefining geriatric preoperative assessment using frailty, disability and co-morbidity.Ann Surg. 2009; 250: 449
- Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults.Am J Surg. 2011; 202: 511
- Simple frailty score predicts postoperative complications across surgical specialties.Am J Surg. 2013; 206: 544
- Frailty as a predictor of surgical outcomes in older patients.J Am Coll Surg. 2010; 210: 901
- Too frail for surgery? Initial results of a large multidisciplinary prospective study examining preoperative variables predictive of poor surgical outcomes.J Am Coll Surg. 2013; 217: 665
- Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery.Circulation. 2010; 121: 973
- Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized.Am J Surg. 2012; 204: 139
- Frailty is associated with postoperative complications in older adults with medical problems.Arch Gerontol Geriatr. 2009; 48: 78
- Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy.Eur Urol. 2008; 54: 785
- Pretreatment expectations of patients undergoing robotic assisted laparoscopic or open retropubic radical prostatectomy.J Urol. 2012; 187: 894
- Patient satisfaction as a possible indicator of quality surgical care.JAMA Surg. 2013; 148: 362
- Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients.Br J Anaesth. 2000; 84: 6
- Relationships between patients' pre-treatment expectations of toxicities and post chemotherapy experiences.Psychooncology. 2005; 14: 25
- When expectations predict experience: the influence of psychological factors on chemotherapy toxicities.J Pain Symptom Manage. 2012; 43: 1036
- The assessment of patient life-expectancy: how accurate are urologists and oncologists?.BJU Int. 2005; 95: 794
- Perception of quality of life by patients, partners and treating physicians.Qual Life Res. 2000; 9: 1041
- Patient-physician concordance in problem identification in the primary care setting.Ann Intern Med. 1980; 93: 490
- Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146
- Measurement of pain.Lancet. 1974; 2: 1127
- Measurement of subjective phenomena in primary care research: the visual analogue scale.Fam Pract Res J. 1993; 13: 15
- Variability in the American Society of Anesthesiologists physical status classification scale.AANA J. 2003; 71: 265
- An assessment of the consistency of ASA physical status classification allocation.Anaesthesia. 1995; 50: 195
- Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries.J Gerontol A Biol Sci Med Sci. 2009; 64: 675
- Does how you do depend on how you think you'll do? A systematic review of the evidence for a relation between patients' recovery expectations and health outcomes.CMAJ. 2001; 165: 174
- Rehabilitation success: the interrelationships of multiple criteria.J Health Soc Behav. 1978; 18: 36
- Placebo and the new physiology of the doctor-patient relationship.Physiol Rev. 2013; 93: 1207
- Influence of psychological factors on postoperative pain, mood and analgesic requirements.Pain. 1986; 24: 331
- A collection of Physical Activity Questionnaires for health-related research.Med Sci Sports Exerc. 1997; 29: S1
Published online: August 05, 2014
Accepted: July 31, 2014
Received in revised form: July 22, 2014
Received: June 23, 2014
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.