Racial differences in phenotypic frailty assessment among general thoracic surgery patients

Johnathan R Kent; Emily M Silver; Rachel Nordgren; Arianna Edobor; David Fenton; Savanna Kerstiens; Daniel Rubin; Lauren J Gleason; Justine Landi; Megan Huisingh-Scheetz; Darren S Bryan; Mark K Ferguson; Jessica S Donington; Maria Lucia L Madariaga

doi:10.1016/j.xjon.2023.10.001

Racial differences in phenotypic frailty assessment among general thoracic surgery patients

JTCVS Open. 2023 Nov 7:16:1049-1062. doi: 10.1016/j.xjon.2023.10.001. eCollection 2023 Dec.

Affiliations

¹ Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, Ill.
² Department of Psychology, University of Chicago, Chicago, Ill.
³ Department of Public Health Sciences, University of Chicago, Chicago, Ill.
⁴ Department of Anesthesia and Critical Care, University of Chicago, Chicago, Ill.
⁵ Section of Geriatric & Palliative Medicine, Department of Medicine, University of Chicago, Chicago, Ill.

Abstract

Objectives: The American Association for Thoracic Surgery recommends using frailty assessments to identify patients at higher risk of perioperative morbidity and mortality. We evaluated what patient factors are associated with frailty in a thoracic surgery patient population.

Methods: New patients aged more than 50 years who were evaluated in a thoracic surgery clinic underwent routine frailty screening with a modified Fried's Frailty Phenotype. Differences in demographics and comorbid conditions among frailty status groups were assessed with chi-square and Student t tests. Logistic regressions performed with binomial distribution assessed the association of demographic and clinical characteristics with nonfrail, frail, prefrail, and any frailty (prefrail/frail) status.

Results: The study population included 317 patients screened over 19 months. Of patients screened, 198 (62.5%) were frail or prefrail. Frail patients undergoing thoracic surgery were older, were more likely single or never married, had lower median income, and had lower percent predicted diffusion capacity of the lungs for carbon monoxide and forced expiratory volume during 1 second (all P < .05). More non-Hispanic Black patients were frail and prefrail compared with non-Hispanic White patients (P = .003) and were more likely to score at least 1 point on Fried's Frailty Phenotype (adjusted odds ratio, 3.77; P = .02) when controlling for age, sex, number of comorbidities, median income, diffusion capacity of the lungs for carbon monoxide, and forced expiratory volume during 1 second. Non-Hispanic Black patients were more likely than non-Hispanic White patients to score points for slow gait and low activity (both P < .05).

Conclusions: Non-Hispanic Black patients undergoing thoracic surgery are more likely to score as frail or prefrail than non-Hispanic White patients. This disparity stems from differences in activity and gait speed. Frailty tools should be examined for factors contributing to this disparity, including bias.

Keywords: frailty; preoperative evaluation; race.

Grants and funding

UL1 TR000430/TR/NCATS NIH HHS/United States