Association of Frailty and 1-Year Postoperative Mortality Following Major Elective Noncardiac Surgery

McIsaac, Daniel I.; Bryson, Gregory L.; Walraven, Carl van

doi:10.1001/jamasurg.2015.5085

Cited by 234 publications

(164 citation statements)

References 40 publications

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“…The present study used the Johns Hopkins ACG frailty‐defining diagnoses indicator and found that the prevalence of frailty was 22% in patients undergoing CABG ≥40 years of age, which is in keeping with the ranges described for other cardiac surgery cohorts. It is, however, markedly higher than the 3.1% prevalence found in a contemporary Ontario noncardiac surgery cohort (2002–2012) aged ≥65 years using the same ACG indicator 5. This higher prevalence of frailty in cardiac surgery patients most likely reflects the higher proportion of medically complex patients presenting for cardiac versus noncardiac surgery.…”

Section: Discussionmentioning

confidence: 68%

“…Three main findings were derived from this study. (1) The burden of frailty was markedly higher in patients undergoing CABG (22%) compared with patients undergoing major noncardiac surgery (3%) during a similar time period in Ontario 5. (2) Frail patients had lower probabilities of early and long‐term survival compared with their nonfrail counterparts.…”

Section: Discussionmentioning

confidence: 99%

“…Assessments of frailty can be made with clinical scales,22 functional assessments,13, 23 and their combination,24 or by the presence of a constellation of frailty‐defining diagnoses 5, 8, 25. This last method uses the Johns Hopkins Adjusted Clinical Groups (ACG) frailty‐defining diagnoses indicator, which is an instrument based on 10 clusters of frailty‐defining diagnoses (ie, malnutrition, dementia, impaired vision, decubitus ulcer, incontinence of urine, loss of weight, poverty, barriers to access to care, difficulty in walking, and falls; Table S1).…”

Section: Methodsmentioning

confidence: 99%

“…This binary indicator identifies frailty by the presence of ≥1 diagnostic clusters and was designed and validated for research of frailty‐related outcomes and resource use using administrative data 26, 27, 28, 29, 30. It has been used to study the prevalence, outcomes, and resource use in patients undergoing major elective noncardiac surgery5 and total joint arthroplasty in Ontario 8. Because of the proprietary nature of the ACG system, the authors are unable to provide the specific diagnostic codes used to define this indicator.…”

Section: Methodsmentioning

confidence: 99%

“…It is increasing in prevalence and presents a formidable challenge for clinicians who work to optimize these patients 5. Frailty is a common syndrome described as a diminished resiliency in response to stress as a result of decreased physiological reserve, increased burden of comorbidities, and altered multisystem homeostasis 6.…”

Section: Introductionmentioning

confidence: 99%

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Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

102

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BackgroundFrailty is increasing in prevalence and poses a formidable challenge for clinicians. The cardiac surgery literature consists primarily of small single‐center studies with limited follow‐up, and the epidemiological features of frailty remain to be elucidated in long‐term follow‐up.Methods and ResultsWe conducted a population‐based, retrospective, cohort study in Ontario, Canada, between 2008 and 2015. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator (a multidimensional instrument validated for research using administrative data). The primary outcome was mortality. Mortality rates were calculated using the Kaplan‐Meier method. The hazard of death was assessed using a multivariable Cox proportional hazard model. Of 40 083 patients, 8803 (22%) were frail. At 4±2 years of follow‐up, age‐ and sex‐standardized mortality rate per 1000 person‐years was higher in frail (33; 95% confidence interval, 29–36) compared with nonfrail (22; 95% confidence interval, 19–24) patients. Frailty was associated with an increased risk of long‐term mortality (adjusted hazard ratio, 1.20; 95% confidence interval, 1.12–1.28) and greater differences in the survival of patients between 40 and 74 years of age than in those who were ≥85 years old.ConclusionsFrailty was present in a large proportion of patients undergoing coronary artery bypass grafting and was independently associated with long‐term mortality. The adjusted risk of frailty‐related death was inversely proportional to age. Our findings highlight the need for more comprehensive preoperative risk stratification models to assist with optimal selection of operative candidates. In addition, we identified the <75 years age group as a potential target for comprehensive preoperative optimization programs, such as cardiac prehabilitation, nutritional augmentation, and psychosocial support.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Tran

Dupuis

et al. 2018

JAHA

102

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Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery

et al. 2018

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IMPORTANCE Overlapping surgery, also known as double-booking, refers to a controversial practice in which a single attending surgeon supervises 2 or more operations, in different operating rooms, at the same time. OBJECTIVE To determine if overlapping surgery is associated with greater risk for complications following surgical treatment for hip fracture and arthritis. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study in Ontario, Canada (population, 13.6 million), for the years 2009 to 2014. There was 1 year of follow-up. This study encompassed 2 large cohorts. The "hip fracture" cohort captured all persons older than 60 years who underwent surgery for a hip fracture during the study period. The "total hip arthroplasty" (THA) cohort captured all primary elective THA recipients for arthritis during the study period. We matched overlapping and nonoverlapping hip fractures by patient age, patient sex, surgical procedure (for the hip fracture cohort), primary surgeon, and hospital. EXPOSURES Procedures were identified as overlapping if they overlapped with another surgical procedure performed by the same primary attending surgeon by more than 30 minutes. MAIN OUTCOMES AND MEASURES Complication (infection, revision, dislocation) within 1 year. RESULTS There were 38 008 hip fractures, and of those, 960 (2.5%) were overlapping (mean age of patients, 66 years [interquartile range, 57-74 years]; 503 [52.4%] were female). There were 52 869 THAs and of those, 1560 (3.0%) overlapping (mean age, 84 years [interquartile range, 77-89 years]; 1293 [82.9%] were female). After matching, overlapping hip fracture procedures had a greater risk for a complication (hazard ratio [HR], 1.85; 95% CI, 1.27-2.71; P = .001), as did overlapping THA procedures (HR, 1.79; 95% CI, 1.02-3.14; P = .04). Among overlapping hip fracture operations, increasing duration of operative overlap was associated with increasing risk for complications (adjusted odds ratio, 1.07 per 10-minute increase in overlap; P = .009). CONCLUSIONS AND RELEVANCE Overlapping surgery was relatively rare but was associated with an increased risk for surgical complications. Furthermore, increasing duration of operative overlap was associated with an increasing risk for complications. These findings support the notion that overlapping provision of surgery should be part of the informed consent process.

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Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair

et al. 2019

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Key Points Question Is surgery duration associated with postoperative delirium in patients receiving hip fracture repair? Findings In this population-based cohort study of 68 131 adults, increasing surgery duration was associated with a higher risk-adjusted likelihood of postoperative delirium (6% increase in delirium risk per additional half hour of surgery). This risk was higher in patients who received a general anesthetic. Meaning The findings suggest that prolonged surgery is associated with increased postoperative delirium, particularly when the patient has received a general anesthetic.

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Association of Frailty and 1-Year Postoperative Mortality Following Major Elective Noncardiac Surgery

Abstract: At a population level, preoperative frailty-defining diagnoses were associated with a significantly increased risk of 1-year mortality that was particularly notable in the early postoperative period, in younger patients, and after joint arthroplasty.

Cited by 234 publications

References 40 publications

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

Association of Overlapping Surgery With Increased Risk for Complications Following Hip Surgery

Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair

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