Background and Goal of Study: The concept of frailty describes a state of increased vulnerability and is a significant predictor of adverse outcomes. We aim to evaluate the incidence of frailty in patients with neoplastic disease and the impact of this condition in postoperative recovery.
Materials and Methods: After approval by the institutional ethics committee, an observational, prospective study was conducted. Adult patients submitted to elective curative neoplastic surgery, and admitted to the Post Anaesthetic Care Unit (PACU) were included. RCRI was applied. Frailty patients (FP) were considered patients with a score ≥4 in the Clinical Frailty Scale. EQ-5D VAS was use to measure quality of life before surgery. Postoperative Quality of Recovery Scale (PQRS) was used at baseline and after surgery at minute 15 (T15), 40 (T40) and days 1(D1) and 3 (D3) to evaluate 5 domains: physiologic (PD), nociceptive (ND), emotional (ED), functional (FD) and cognitive (CD). Quality of Recovery 15 (QoR-15) was evaluated and Poor Quality of Recovery (PQR) was considered using a calculation (mean D1 QoR-15 score minus 1 SD). The Mann-Whitney test, Chi-square or Fisher's exact test were used.
Results and Discussion: Of 148 patients, 30% were frail (FP). FP were older (p< 0.001), had more frequently coronary heart disease (31%vs.6%, p< 0.001), heart failure (24%vs.6%, p=0.001), insulin dependent diabetes (13%vs2%, p=0.010), chronic kidney disease (13%vs.2%, p=0.01) and higher otal RCRI (33%vs.10%,p< 0.001). FP had more problems at EQ-5D dimensions: in mobility (73% vs.11%,p< 0.001), self-care (47%vs.2%, p< 0.001), usual activities (71%vs11%, p< 0.001), pain (62%vs.24%, p< 0.001) and worst median EQ-VAS (50vs.70, p< 0.001). FP presented lower global median QoR-15 scores at D0 (114vs.134, p< 0.001) but not at D1. PQR was observed more frequently in FP (50%vs.27%, p=0.030). FP had more frequently incomplete recovery in ND, at all time frames, T15 (p=0.002), T40 (p=0.012), D1 (p=0.021) and D3 (p< 0.001). At D1 FP had incomplete recovery in PD (p=0.014).
Conclusion: The incidence of frailty was 30%. FP were older, had higher RCRI and worst health status prior surgery. QoR-15 identified PQR in frail neoplastic patients and PQRS revealed incomplete recovery in FD at D1 and in ND at all time frames

Preoperative frailty and quality of recovery after curative neoplastic surgery