The Impact of Frailty and Age on Older Patients Undergoing Plastic Surgery at a Quaternary Center in Brazil

Abstract

Background: An aging population brings with it an older cohort of patients undergoing plastic surgery. Identifying and understanding risk factors related to surgical outcomes is critical. The literature diverges regarding the impact of age. Associated with age is the modifiable condition of frailty. This is a retrospective case control study examining the effect of age and frailty on perioperative outcomes in the plastic surgery setting. Methods: A cohort of elderly patients undergoing plastic surgery at the Hospital das Clínicas da Faculdade de Medicina de Botucatu between 2013 and 2020 was collected to medical chart review. The independent variables analyzed were age, sex, comorbidities, surgery performed, and modified 5-item frailty index. The outcomes evaluated were perioperative and postoperative complications, rehospitalization within 1 month, and mortality within 1 month after surgery. Results: We identified 229 patients, with a mean age of 70.1 ± 8.8 years. The majority were women (54.6%). The most prevalent comorbidities were systemic arterial hypertension (62.4%) and smoking (27.5%). Frailty score (modified 5-item frailty index) of 2 or more impacted readmission at 30 days (<i>P</i> = 0.012). A total of 43 (18.8%) patients were 80 years of age or older, and 28 (65.1%) were women. There were no statistical differences among the surgical outcomes among octogenarians and the younger group. Conclusions: Frail elderly patients had higher readmission rate at 30 days of follow-up. In our cohort, frailty score was more effectively than age in predicting poorer postoperative outcomes.