Validation of the Self-Reported Domains of the Edmonton Frail Scale in Patients 65 Years of Age and Older

Introduction: In the era of virtual care, self-reported tools are beneficial for preoperative assessments and facilitating postoperative planning. We have previously reported the use of the Edmonton Frailty Scale (EFS) as a valid preoperative assessment tool. Objective: We wished to validate the self-reported domains of the EFS (srEFS) by examining its association with loss of independence (LOI) and mortality. Methods: : This is a single-institution observational study of patients ≥ 65 years undergoing multi-specialty surgical procedures who were assessed preoperatively with the EFS. Exploratory data analysis of the EFS was used to determine the threshold for identifying frailty on the srEFS. Procedures were classified using the Operative Stress Score (OSS) scored 1 – 5 (lowest to highest). Hierarchical Condition Category (HCC) was utilized to risk-adjust. LOI was described as a change in functional status at discharge and mortality was defined as in-hospital or up to 30 days following discharge. Receiver operating characteristic (ROC) curves were used to estimate areas under the curves for srEFS versus EFS in relation to LOI and 30-day mortality. Results: : 535 patients were included. Exploratory analysis confirmed best positive predictive value for srEFS was ³5. Overall, 113 (21%) patients were frail and 179 (33.5%) patients had an 0SS ³5. LOI occurred in 38 (7%) patients and the mortality rate was 4% (21 patients). ROC analysis showed that the srEFS performed similarly the standard EFS with no difference in discriminatory thresholds for predicting LOI and mortality. Examination of the domains of the EFS demonstrated a lack of association between cognitive decline and the outcomes of interest. However, functional status assessed with either the Get up and Go or self-reported ADLs was independently associated with increased risk for LOI. Conclusion: This study shows that self-reported components EFS are sufficiently valid as a high-risk assessment and are useful in virtual preoperative evaluation to help predict LOI and mortality.