Frailty trajectory and its associated factors in older patients after major abdominal surgery: A longitudinal study

Abstract Background: Frailty is a common multifactorial clinical syndrome in older patients that seriously affects their prognosis. However, most studies to date have ignored the dynamics of frailty.The purpose of this study was to explore the frailty status and changes in older patients who underwent major abdominal surgery, identify the different categories of frailty trajectories, and analyze the factors. Methods: We employed a three-month observational longitudinal study.155 older patients who underwent major abdominal surgery were assessed preoperatively, at discharge, and at one-month follow-up. Data collection included frailty scores, specific demographic and clinical characteristics, and scores for the influencing factors. A latent class growth model was used to explore the frailty trajectories. Multiple logistic regression analysis was conducted to identify factors influencing the frailty trajectories. The STROBE checklist was used in the reporting of this study. Results: Four frailty trajectory patterns were identified among the 155 older patients (average age: 70.38±0.55 years): No frailty (20.1%), frailty exacerbation (39.6%), frailty improvement (13.6%), and persistent frailty (26.7%). Logistic regression analysis showed that body mass index, Charlson comorbidity index score, type of surgery, intraoperative drainage tube retention time (drainage time), first time to get out of bed after surgery, the time of the first oral feed after surgery, postoperative complications, mobility, nutritional risk, and anxiety were associated with frailty trajectories. Conclusion: We identified four frailty trajectories in older patients after major abdominal surgery and found that these were influenced by multiple factors. Focusing on individual specificity is conducive to accurately dealing with frailty-associated clinical problems and guiding relevant nursing decisions.