Implementation of Vulnerable Elders Survey-13 Frailty Tool to Identify At-Risk Geriatric Surgical Patients

Vulnerability to functional decline is associated with noncardiovascular cause of 90‐day readmission in hospitalized patients with heart failure

“…shown to be feasible for use in a wide variety of clinical settings and easy to administer. 11,[26][27][28] It can be completed directly by the patient or administered via structured interview, as was the case in this study, and scored by a nonclinician, with administration and scoring totaling less than 5 min. 14 By contrast, the assessments of frailty most commonly used among patients with HF require physical testing such as grip strength and walking speed, 35 which can be complicated to administer in the hospital, especially for patients with intravenous T A B L E 3 Effect estimates of association between each independent variable and the cause of readmission outcome within 90 days of hospital discharge (cardiovascular cause readmission and noncardiovascular cause readmission versus the reference category of no readmission) using a multinomial logistic model.…”

“…Previous work, primarily focused on adults in the outpatient setting, has shown that the VES‐13 score is predictive of functional decline and mortality at 1, 2, and 5 years 14,15,25 . Although this instrument was originally used to target outpatient interventions, 14 it has proven easy to administer and appropriate for use in a wide variety of clinical settings 11,26–28 . For this study, during the enrollment interview in the hospital, a study team member asked patients to answer the VES‐13 questions in reference to their general functional abilities before hospitalization.…”

Preoperative Evaluation of the Frail Patient

“…13 The VES has also been successfully administered over the telephone. 12 With the right tools and appropriate training, both PFP and DAI can be performed in a clinic setting. 5,66 It is less clear what should be done once a patient is identified as frail and is scheduled to undergo an elective or emergent surgical procedure.…”

“…Two studies that did not show significant association of frailty with LOS examined elective general surgery and vascular procedures and, in general, had smaller samples compared to the studies that showed significant associations. 12,38 One study using 2 different frailty assessment tools in elective total joint replacement patients showed that the frailty status categorized by the CFS was significantly associated with LOS while those categorized by FRAIL scale was not. 42 The CFS is based on the deficit accumulation model, 18 and the FRAIL scale is based more on Fried's phenotypic model.…”

“…Smaller sample size may have contributed to the nonsignificant findings between frailty status and LOS in this study. 12 Postoperative Mortality.-Twenty-five studies specifically examined associations between frailty status and 30-day mortality. One study by McIsaac et al 50 examining independent, community-dwelling patients demonstrated that mortality was particularly high among frail patients in the immediate postoperative period.…”