The perioperative impact of frailty and cognitive impairment in older surgical patients: A multicentered longitudinal cohort study
Bibliographic record
Abstract
INTRODUCTION: Frailty and cognitive impairment (CI) are prevalent conditions that often co-exist in older patients and lead to worse perioperative outcomes. Despite this, these conditions are not routinely assessed preoperatively, and their impact and interactions during the perioperative period remain poorly understood. Using ultra-rapid screening tools, this study aimed to (1) compare the perioperative prevalence and trajectory of frailty between patients with and without CI and (2) investigate patient-reported outcome measures and clinical outcomes associated with preoperative frailty and CI. METHODS: This multicentered longitudinal cohort study assessed CI and frailty in 370 older non-cardiac surgical patients using ultra-rapid screening tools: the Ascertain Dementia Eight-item Questionnaire (AD8) (cutoff: ≥2) and 5-item FRAIL Questionnaire (prefrail: 1-2; frail: ≥3). The trajectories of frailty in CI versus no-CI patients were analyzed using a linear mixed-effects model. Univariable and multivariable logistic regressions were conducted to identify risk factors associated with preoperative frailty. MAIN RESULTS: Up to 63% of older surgical patients experienced preoperative prefrailty (48%) or frailty (15%). Eighty-one percent of patients with preoperative CI were preoperatively prefrail (49%) or frail (32%). Patients with CI were more frail at all postoperative time points than no-CI patients. Patients classified as prefrail/frail preoperatively had longer length of stay, greater incidence of non-home discharge, and composite outcomes at 30 days than robust patients. Patients with combined prefrailty/frailty and CI experienced significantly worse 90-day composite outcomes than those with prefrailty/frailty alone. In the multivariable analysis, females (3-fold), orthopedic surgery (7-fold), significant preoperative functional disability (6-fold), and high risk of obstructive sleep apnea (5-fold) were significantly associated with preoperative frailty. CONCLUSIONS: Patients with preoperative CI were significantly more frail at all perioperative time points than those without. While preoperative prefrailty/frailty was associated with significantly worse 30-day outcomes, only patients with combined prefrailty/frailty and CI experienced worse long-term outcomes at 90 days.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".