Background Frailty is a measure of physiologic reserve associated with increased vulnerability to adverse outcomes following surgery in older adults. The ‘accumulating deficits’ model of frailty has been applied to the NSQIP database, and an 11-item modified frailty index (mFI) has been validated. We developed a condensed 5-item frailty index and used this to assess the relationship between frailty and outcomes in patients undergoing paraesophageal hernia (PEH) repair. Methods The NSQIP database was queried for ICD-9 and CPT codes associated with PEH repair. Subjects ≥60 years who underwent PEH repair between 2011 and 2013 were included. Five of the 11 mFI items present in the NSQIP data on the most consistent basis were selected for the condensed index. Univariate and multivariate logistic regressions were used to determine the validity of the 5-item mFI as a predictor of postoperative mortality, complications, readmission, and non-routine discharge. Results A total of 3711 patients had data for all variables in the 5-item index, while 885 patients had complete data to calculate the 11-item mFI. After controlling for competing risk factors, including age, ASA score, wound classification, surgical approach, and procedure timing (emergent vs non-emergent), we found the 5-item mFI remained predictive of 30-day mortality and patients being discharged to a location other than home (p < 0.05). A weighted Kappa was calculated to assess agreement between the 5-item and 11-item mFI and was found to be 0.8709 (p < 0.001). Conclusions Frailty, as assessed by the 5-item mFI, is a reasonable alternative to the 11-item mFI in patients undergoing PEH repair. Utilization of the 5-item mFI allows for a significantly increased sample size compared to the 11-item mFI. Further study is necessary to determine whether the condensed 5-item mFI is a valid measure to assess frailty for other types of surgery.
Background Frailty is a measure of physiologic reserve that has been used to predict outcomes following surgical procedures in the elderly. We hypothesized that frailty would be associated with outcomes following paraesophageal hernia (PEH) repair. Methods The National Surgical Quality Improvement Program (NSQIP) database (2011–2013) was queried for ICD-9 and CPT codes associated with PEH repair in patients ≥ 60 years old. A previously described modified frailty index (mFI), based on 11 clinical variables in NSQIP was used to quantify frailty. Multivariate logistic regression was used to determine the relationship between frailty, complications, and mortality. Results Of the 4434 PEH repairs that met inclusion criteria, 885 records were included in the final analysis (20%). Excluded patients were missing 1 or more variables in the mFI. The rate of complications that were Clavien-Dindo Grade ≥ 3 was 6.1%. Mortality was 0.9%. The readmission rate was 8.2%, and 10.9% of patients were discharged to a facility other than home. Relative to mFI scores of 0, 1, 2, and ≥3, the respective occurrence percentages were as follows; Grade ≥3 complication: 3.2%, 4.7%, 9.8%, and 23.3% (p<0.0001) [OR 3.51; CI 1.46–8.46]; mortality: 0.0%, 0.9%, 1.8%, and 2.3% (p 0.0974); discharge to facility other than home: 4.4%, 10.9%, 15.7%, and 31.7% (p<0.0001) [OR 4.07; CI 1.29–12.82]; and readmission: 8.9%, 6.8%, 8.5%, and 16.3% (p=0.1703) [OR 1.01; CI 0.36–2.84]. Complications and discharge destination were significantly correlated with the mFI. Conclusion Frailty, as assessed by the mFI, is correlated with postoperative complications and discharge to a facility other than home following paraesophageal hernia repair.
This study demonstrates that TIF can produce durable improvements in disease-specific quality of life in some patients with symptomatic GERD. The majority of patients resumed daily PPI therapy during the study period, but with significantly improved GERD-HRQL scores compared to baseline and increased satisfaction with their medical condition.
HighlightsA “replaced” artery is a totally replaced variant artery in the absence of the normal artery that has the same name.The gastroduodenal artery supplies arterial perfusion to the head of the pancreas.Arterial anomalies need to be identified and managed appropriately during surgery to prevent end organ ischemia.
Objective(s):In an attempt to identify the concerns of vascular fellows regarding their training in vascular surgery, we conducted an anonymous survey consisting of 22 questions at an annual national meeting held yearly in March from 2004 to 2010.Methods: The fellows were asked to assess their endovascular, open, and vascular laboratory experience as excellent, satisfactory, or mixed. They were queried about who trained them in their endovascular skills, the quality of their didactics, and amount of small cases that yielded no learning experience. Of the 466 attendees, 376 (80%) completed the survey. Up to 84% of those surveyed were men. Second-year fellows comprised up to 66% of those surveyed.Results: Most (79%) were satisfied with their endovascular experience during their fellowship, and 81% were satisfied with their experience with open cases. Interventional skills were obtained from a vascular surgeon (84%), an interventional radiologist (9%), a cardiologist (1%), or a mixture (5%). The didactics were felt to be excellent, satisfactory, or required some or much improvement in 20%, 64%, 11%, and 4% respectively. The distribution of nonlearning cases was felt to be excellent, satisfactory, or required some or much improvement in 42%, 45%, 10%, and 3% respectively. However, only 64% thought their vascular laboratory experience was excellent or satisfactory. Only 36% actually performed the vascular duplex examination, and only 47% felt that they would feel comfortable in managing a vascular laboratory. Forty-six percent suggested that finding the type of job they wanted was easy in 46% or moderately difficult in 46%. Most (72%) felt that future demand for manpower in vascular surgery will exceed available manpower. In the 2004 survey, the primary source of training for interventional skill was a vascular surgeon in 77% and this increased to 100% in 2010. No other major significant differences were noted from year to year.Conclusions: The results of this survey suggest that several significant issues are reflected in the minds of vascular trainees. These data suggest that vascular fellows are not being adequately trained in the vascular laboratory. Because the trainees represent the future of our field, we suggest that the vascular laboratory become a specific area of focus in the fellowship training.
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