Difficulty climbing stairs or walking one block on the FRAIL scale is associated with adverse postoperative outcomes in older surgical patients.

Background

Frail individuals represent a high-risk group for postoperative complications. The FRAIL (Fatigue, Resistance, Ambulation, Illnesses, and Weight Loss) scale is a self-reported tool for assessing frailty. While prior studies have linked overall FRAIL scores with adverse outcomes, the association of individual questions with postoperative complications has never been extensively studied.

Methods

This post-hoc analysis included 677 surgical participants aged ≥65 years from the Postoperative Functional Disability in Unrecognized Cognitive Impairment (POF) and Detection of Cognitive Impairment (Detect-CI) studies. Preoperative frailty was assessed using the 5-item FRAIL scale. Multiplicity-adjusted multivariable logistic and linear regression models were used to examine associations between frailty status and individual FRAIL questions with postoperative outcomes.

Results

Among the five individual FRAIL questions, inability to climb one flight of stairs (Q2: resistance) was most associated with postoperative outcomes. Participants reporting difficulty with resistance had higher odds of 30-day non-home discharge (OR: 2.47, 95% CI: 1.43, 4.33), composite adverse outcomes (OR: 1.68, 95% CI: 1.14, 2.49), and 22% longer hospital stay (β: 0.20, 95% CI: 0.08, 0.32). The individual question on inability to walk one block (Q3: ambulation) was also associated with higher odds of 30-day non-home discharge (OR: 2.93, 95% CI: 1.67, 5.31) and 19% longer hospital stay (β: 0.18, 95% CI: 0.06, 0.29).

Conclusions

Of the five FRAIL scale questions, difficulty climbing one flight of stairs (resistance) was most associated with 30-day postoperative outcomes, followed by difficulty walking one block (ambulation). In busy preoperative clinics, these two yes/no questions may offer a quick and practical screening approach for identifying high-risk patients and those in need of prehabilitation.