Association of Frailty and Postoperative Complications With Unplanned Readmissions After Elective Outpatient Surgery

Rothenberg, Kara A.; Stern, Jordan R.; George, Elizabeth; Trickey, Amber W.; Morris, Arden M.; Hall, Daniel E.; Johanning, Jason M.; Hawn, Mary T.; Arya, Shipra

doi:10.1001/jamanetworkopen.2019.4330

Cited by 67 publications

(56 citation statements)

References 56 publications

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“… 4 It has become a well-established predictor of poor postoperative outcomes including an increased risk for complications and a longer length of stay in many of the surgical sub-specialties. 5 , 6 , 7 Recently, Berian et al demonstrated that the increase in complications seen in our older patient population was significantly associated with an increased rate of loss of independence and early mortality. 8 Frail surgical patients who suffer loss of independence often are placed in skilled nursing facilities upon discharge from the hospital.…”

Section: Introductionmentioning

confidence: 82%

Preoperative Frailty Assessment, Operative Severity Score, and Early Postoperative Loss of Independence in Surgical Patients Age 65 Years or Older

Owodunni¹,

Mostales

Qin³

et al. 2021

Journal of the American College of Surgeons

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Introduction Preoperative discussion around postoperative discharge planning have been amplified by the COVID pandemic. We wish to determine if our preoperative frailty screen would predict postoperative LOI. Methods This single-institutional study included demographical, procedural, and outcome data from patients ≥65 years who underwent frailty screening prior to a surgical procedure. Frailty was assessed using the Edmonton Frailty Score (EFS). The Operative Severity Score was used to categorize procedures. The Hierarchical Condition Category (HCC) risk-adjustment score as calculated by CMS was included. LOI was defined as an increase in support outside of the home following discharge. Univariable, multivariable logistic regressions, and adjusted post-estimation analyses for predictive probabilities of best fit were performed. Results 535 patients met inclusion and LOI was seen in 38 (7%) patients. Patients with LOI were older, had a lower BMI, a higher EFS score (7vs.3.0, p<0.001), and a higher HCC score than patients without LOI. Being frail and undergoing a procedure with an OSS ≥ 3 was independently associated with an increased risk of LOI. In addition, social dependency, depression, and limited mobility was associated with an increased risk for LOI. On multivariable modeling, frailty status, undergoing a surgery with an OSS ≥ 3, and having an HCC score ≥ 1 was the most predictive of LOI (OR 12.72, 95% CI: 12.04, 13.44, p<0.001). In addition, self-reported depression, weight loss, and limited mobility was associated with a nearly 11-fold increase risk in postoperative LOI. Conclusions This study is novel as it identifies clear, generalizable risk factors for LOI. In addition, our findings support the implementation of preoperative assessments to aid in care coordination and provide specific targets for intervention.

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Section: Introductionmentioning

confidence: 82%

Preoperative Frailty Assessment, Operative Severity Score, and Early Postoperative Loss of Independence in Surgical Patients Age 65 Years or Older

Owodunni¹,

Mostales

Qin³

et al. 2021

Journal of the American College of Surgeons

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“…Most studies investigating the relationship between preoperative frailty and postoperative outcome only assess frailty retrospectively [12–14], indirectly estimating crucial frailty criteria, such as weakness and exhaustion. Evidence is still lacking as to whether patients benefit from a routine frailty assessment followed by an individualized treatment plan.…”

Section: Introductionmentioning

confidence: 99%

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

et al. 2019

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BackgroundFrailty is a frequent and underdiagnosed functional syndrome involving reduced physiological reserves and an increased vulnerability against stressors, with severe individual and socioeconomic consequences. A routine frailty assessment was implemented at our preoperative anaesthesia clinic to identify patients at risk.ObjectiveThis study examines the relationship between frailty status and the incidence of in-hospital postoperative complications in elderly surgical patients across several surgical disciplines.DesignRetrospective observational analysis.SettingSingle center, major tertiary care university hospital. Data collection took place between June 2016 and March 2017.PatientsPatients 65 years old or older were evaluated for frailty using Fried’s 5-point frailty assessment prior to elective non-cardiac surgery. Patients were classified into non-frail (0 criteria, reference group), pre-frail (1–2 positive criteria) and frail (3–5 positive criteria) groups.Main outcome measuresThe incidence of postoperative complications was assessed until discharge from the hospital, using the roster from the National VA Surgical Quality Improvement Program. Propensity score matching and logistic regression analysis were performed.ResultsFrom 1186 elderly patients, 46.9% were classified as pre-frail (n = 556), and 11.4% as frail (n = 135). The rate of complications were significantly higher in the pre-frail (34.7%) and frail groups (47.4%), as compared to the non-frail group (27.5%). Similarly, length of stay (non-frail: 5.0 [3.0;7.0], pre-frail: 7.0 [3.0;9.0], frail 8.0 [4.5;12.0]; p < 0.001) and discharges to care facilities (non-frail:1.6%, pre-frail: 7.4%, frail: 17.8%); p < 0.001) were significantly associated with frailty status. After propensity score matching and logistic regression analysis, the risk for developing postoperative complications was approximately two-fold for pre-frail (OR 1.78; 95% CI 1.04–3.05) and frail (OR 2.08; 95% CI 1.21–3.60) patients.ConclusionsThe preoperative frailty assessment of elderly patients identified pre-frail and frail subgroups to have the highest rate of postoperative complications, regardless of age, surgical discipline, and surgical risk. Significantly increased length of hospitalisation and discharges to care facilities were also observed. Implementation of routine frailty assessments appear to be an effective tool in identifying patients with increased risk. Now future studies are needed to investigate whether patients benefit from optimization of patient counselling, process planning, and risk reduction protocols based on the application of risk stratification.

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“…Frailty has been shown to be associated with multiple complications after surgery. 6,7 This study investigated the association between frailty and outcomes after elective craniotomy for the resection of brain tumors. 5 Frailty assessment was based on a 5-factor modified frailty index (mFI-5) and classified as nonfrail (mFI-5 = 0), low frailty (mFI = 0.2), or medium to high frailty (mFI > 0.2).…”

Section: Frailty and Outcomes After Brain Tumor Surgerymentioning

confidence: 99%

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2020

Esmail

Subramaniam

Venkatraghavan

2021

Journal of Neuroanaesthesiology and Critical Care

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This review is a synopsis of selected articles from neuroscience, neuroanesthesia, and neurocritical care from the year 2020 (January–December 2020). The journals reviewed include anesthesia journals, critical care medicine journals, neurology and neurosurgical journals, as well as high-impact medical journals such as the Lancet, Journal of American Medical Association, New England Journal of Medicine, and Stroke. This summary of important articles will serve to update the knowledge of anesthesiologists and other perioperative physicians who provide care to neurosurgical and neurocritical care patients. In addition, some of the important narrative reviews that are of interest to neuroanesthesiologists are also listed.

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Association of Frailty and Postoperative Complications With Unplanned Readmissions After Elective Outpatient Surgery

Cited by 67 publications

References 56 publications

Preoperative Frailty Assessment, Operative Severity Score, and Early Postoperative Loss of Independence in Surgical Patients Age 65 Years or Older

Preoperative Frailty Assessment, Operative Severity Score, and Early Postoperative Loss of Independence in Surgical Patients Age 65 Years or Older

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2020

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