In reply: What is the appropriate definition for vulnerability to identify silent pre-frail patients?
- PDF / 248,490 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 86 Downloads / 179 Views
CORRESPONDENCE
In reply: What is the appropriate definition for vulnerability to identify silent pre-frail patients? Han Ting Wang, MD, MSc
. Franc¸ois Martin Carrier, MD, MSc
Received: 14 July 2020 / Revised: 14 July 2020 / Accepted: 14 July 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, Even as the concept of frailty is increasingly being described, it remains an elusive one to clearly define. As Drs Le Maguet and Gueret astutely pointed out,1 we described different frailty instruments that have moderate agreement at best.2 Similarly, the pre-frail or vulnerable state suffers from varying definition, making its use and interpretation challenging. Nevertheless, if we consider vulnerability as a transitional state toward frailty, vulnerable patients are ‘‘less ill’’ than frail patients are. This is reflected in our study by the higher proportion of American Society of Anesthesiologists physical status score C 3 among frail patients (53.3%) compared with vulnerable patients (42.5%), even though the median Charlson Comorbidity Index did not differ.3 Hence, vulnerability probably has less impact on clinical outcomes then frailty does. Nevertheless, with only 87 vulnerable patients included, this relationship was difficult to tease out.
The reply letter is related to letter 20-00591. H. T. Wang, MD, MSc (&) Department of Medicine, Division of Internal and Critical Care Medicine, Hoˆpital Maisonneuve-Rosemont, Universite´ de Montre´al, Montreal, QC, Canada e-mail: [email protected] F. M. Carrier, MD, MSc Department of Anesthesia and Department of Medicine, Critical Care Division, Centre hospitalier de l’Universite´ de Montre´al, Montre´al, Canada Department of Anesthesiology and Pain Medicine, Universite´ de Montre´al, Centre de recherche du CHUM, Montre´al, QC, Canada
Since the Clinical Frailty Scale (CFS) has a more subjective interpretation then the Fried phenotype, we thought that some patients might have underestimated their frailty state. In our sensitivity analysis, by reclassifying patients with CFS = 3 as vulnerable, we probably introduced some more robust patients into our vulnerable category, which diluted and reduced the observed effect of vulnerability on our clinical outcomes. Although this sensitivity analysis had more power than the main analysis, its purpose was to explore the effect of potential vulnerability misclassification. Duration of postoperative hospital length of stay (LOS) is dependent on the type of surgery performed. For every surgical specialty, minor procedures have a shorter LOS compared with major ones. Similarly, in our study, performing a major surgery had the strongest effect on LOS (adjusted odds ratio, 2.37). We did not explore how frailty and vulnerability may interact with the invasiveness of surgical procedures (i.e., effect modification). For example, vulnerability might not be important for very minor surgeries, such as hernia repairs. To our knowledge, such effect modification has not been assessed but should be further evaluated. As mentioned by Dr. L
Data Loading...
