Abstract
Purpose
As the global population ages and older patients undergo surgery, understanding the association between frailty and post-operative outcomes is crucial to informed decision-making and patient care. There is a lack of research assessing the association between frailty and long-term outcomes in patients admitted to intensive care units (ICUs) post-operatively.
Methods
We conducted a multicentre retrospective cohort study using Australian and New Zealand Intensive Care Society Adult Patient Database, linked with the Australian National Death Index. Adults aged ≥ 16 years admitted to the 175 ICUs in Australia between January 1st, 2018, and March 31st, 2022, following surgery were included. Frailty was assessed using the Clinical Frailty Scale (CFS), and patients with CFS ≥ 5 were considered frail. The primary outcome was survival time up to four years after ICU admission. Mixed-effects Cox regression models were used for adjusted analyses.
Results
Of 222,509 patients included, 14.1% were frail. Patients with frailty had shorter overall survival time (median: 16 vs 21 months) and lower survival rates at one, two, three, and four years compared to patients without frailty. After adjusting for confounders, frailty was associated with a shorter time to death (HR: 2.30, 95%-CI: 2.24–2.37). This association was consistent across sensitivity analyses and subgroups, including elective vs. emergency surgery, age groups, and various surgical categories. The association was more pronounced in younger patients (< 65 years), those undergoing elective surgery, and patients without treatment limitations.
Conclusions
In this multicentre study, frailty was associated with worse long-term outcomes amongst post-operative ICU patients. The trend was concordant across all subgroups.