Decision-making for Postoperative Care in Geriatric Patients Undergoing Minor Surgeries using Mini Mental State Examination, Barthel Index of Activities of Daily Living and CSHA-Clinical Frailty Scale

Abstract

Purpose: Prediction of postoperative outcome following major surgery in elderly patients requires a decision-making process based on data on cognitive function, functional status and frailty. In this study, we aimed to evaluate the predictive value of these parameters for minor surgeries. Materials and Methods: Patients aged ≥65 years with American society of Anesthesiologists (ASA) score 1-3 scheduled for elective minor surgery were included in the study. Mini Mental Test (MMSE), Barthel Index (BI) and Clinical Frailty Scale (CSHA-CFS) were used to assess cognitive function, functional status and frailty at hospitalization. The associations of these parameters with postoperative hospitalization status were evaluated. Results: Ninety-nine patients were included in the study. MMSE scores, Barthel Indices and CSHA-CFS scores were similar in all groups. The number of inpatients was higher in patients with MMSE2 (n=19 (82.6%)). The number of inpatients was higher in patients with a frailty score of CSHA-CFS≥4 (n=33 (75%)) (p=0.025) or ASA >2 (n=20 (83.3%)) (p=0.023). Patients with ASA>2 were more likely to have >1 day length of stay (LOS) (p=0.036) and intensive care unit (PACU) stay (p=0.042), independent of the frailty score. Readmission within 30 days was not correlated with the parameters. Conclusion: ASA>2 and MMSE<24 correlate with inpatient status and are independent predictive factors for length of stay of more than one day in the elderly after minor surgery. CSHA-CFS ≥4 was also independently associated with hospitalization.

Keywords

• barthel index
• frailty
• length of stay
• minor surgical procedures
• mmse