Assessing patient frailty in plastic surgery: A systematic review.

ABSTRACT Purpose As the population ages, level of frailty has become an important metric for assessing pre-operative patient risk. While medical and surgical specialties continue to adopt and standardize the use of frailty instruments, few articles within the plastic surgery literature utilise such instruments to predict poor post-operative outcomes. The purpose of this article is two-fold: 1) provide a comprehensive review of existing frailty instruments; and 2) summarise the existing evidence examining the role of pre-operative frailty assessments on peri-operative morbidity and mortality within plastic surgery. Methods This systematic review was registered a priori on Open Science Framework ( https://osf.io/vfzw8 ). A computerized database search of Ovid MEDLINE, EMBASE, and Cochrane was performed from database inception to December 13, 2020. All articles which examined the effect of pre-operative patient frailty on peri-operative morbidity and mortality outcomes following plastic surgery interventions were included for data extraction. Results From the 11 studies included in this review, ten unique frailty instruments were identified. The modified Frailty Index and the Fried Frailty Index were the most commonly reported frailty measurement tools; however, the FRAIL scale was the only outcome measure identified to be valid, reliable, and responsive to change. Regardless of the frailty measure used, nearly all studies reported that worse surgical outcomes were associated with a higher patient frailty score. Conclusion There is a strong association between higher frailty scores and worse post-operative outcomes in plastic surgery. The FRAIL scale is a clinimetrically strong frailty instrument that should be used in all patients to assess peri-operative risk in plastic surgery.