Utility and reliability of the Clinical Frailty Scale in patients scheduled for major vascular surgery: a prospective, observational, multicentre observer-blinded study

Reema Ayyash, Joanne Knight, Elke Kothmann, Mohamed Eid, Katie Ayyash, Kerry Colling, David Yates, Aileen Mill, Gerard Danjoux, Reema Ayyash, Joanne Knight, Elke Kothmann, Mohamed Eid, Katie Ayyash, Kerry Colling, David Yates, Aileen Mill, Gerard Danjoux

Abstract

Background: Frailty is a distinctive health state associated with a loss of physiological reserve that results in higher rates of perioperative complications and impaired return to pre-morbid functional status. It is prevalent in the vascular population; however routine assessment is not common despite national guidance to the contrary. We aimed to evaluate the reliability of the Clinical Frailty Scale in assessing frailty in the surgical vascular population.

Methods: In this prospective, observational, observer-blinded study, we compared assessment of frailty in patients scheduled for major vascular surgery attending the pre-operative assessment clinic using the Clinical Frailty Scale against the Edmonton Frailty Scale. The study investigator completed the Edmonton Frailty Scale assessment; this was compared to the Clinical Frailty Scale assessments performed by the pre-assessment consultant and pre-assessment nurse, who were blinded to the Edmonton Frailty Scale score. The inter-rater reliability of the Clinical Frailty Scale between the pre-assessment consultant and pre-assessment nurse was determined by comparing their frailty scores for each patient.

Results: Ninety-seven patients were included in the analysis (median age 72 years, 84% male and 16% female). There was a moderate level of agreement between the Edmonton and Clinical Frailty Scale score for both consultants (87.6% agreement) and pre-assessment nurses (87.6% agreement). There was a substantial level of agreement between consultants and pre-assessment nurses for the Clinical Frailty Scale (89.7% agreement) CONCLUSIONS: The Clinical Frailty Scale is a useful tool to assess frailty in the vascular surgical population. It is more practical than the Edmonton Frailty Scale: quick to complete, requires minimal training and can be used when physical disability is present.

Trial registration: The study was approved by the Wales Health and Care Research Ethics Service (REC reference 17/WA/0160, IRAS 201173).

Trial registration: NCT03403673. Registered 19 January 2018, https://ichgcp.net/clinical-trials-registry/NCT03403673.

Keywords: Clinical Frailty Scale; Edmonton Frailty Scale; Frailty; pre-operative care; reproducibility of results; vascular surgical procedures.

Conflict of interest statement

Authors RA, JK, EK, ME, KA, KC, DY, AM, and GD declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Participant flow through the study. STHNFT—South Tees Hospitals NHS Foundation Trust. TYH—The York Hospital
Fig. 2
Fig. 2
Frailty classification, using the Edmonton Frailty Scale (EFS) and Clinical Frailty Scale (CFS), of the patients used in primary analysis (n = 97)

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