Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk

Kim, Sun Wook; Han, Ho Seong; Jung, Hee Won; Kim, Kwang Il; Hwang, Dae Wook; Kang, Sung Bum; Kim, Cheol Ho

doi:10.1001/jamasurg.2014.241

Cited by 344 publications

(243 citation statements)

References 30 publications

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“…Most studies were observational (23 of 35) with a total of 1 153 684 patients available for the analysis. Cohorts were composed of patients undergoing lower gastrointestinal (GI) surgery (10 studies), upper GI surgery (6), mixed GI surgery (4), gynaecological surgery (6), urological surgery (4) and mixed abdominal surgery (6) ( Table 1)1 12, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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“…22,[42][43][44][45][46][47][48][49] Most studies have focused on metrics that may predict hospital length of stay and the incidence of postoperative complications and mortality; patient-centered outcomes, including functional impairment, pain, and fatigue, have received less attention. 2 Our findings suggest that the comprehensive assessment of a patient's preoperative immune state may add significant value to predict important surgical recovery parameters as reported immune correlates accounted for up to 50% of observed patient variability.…”

Section: Discussionmentioning

confidence: 99%

Patient-Specific Immune States Before Surgery Are Strong Correlates of Surgical Recovery

Fragiadakis

Gaudillière

Ganio

et al. 2016

Survey of Anesthesiology

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Background-Recovery after surgery is highly variable. Risk-stratifying patients based on their predicted recovery profile will afford individualized perioperative management strategies. Recently, application of mass cytometry in patients undergoing hip arthroplasty revealed strong immune correlates of surgical recovery in blood samples collected shortly after surgery. However, the ability to interrogate a patient's immune state before surgery and predict recovery is highly desirable in perioperative medicine.

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“…However, it was likely that these patients had less accessibility to healthcare resources owing to their cognitive impairment, or that professional caregivers already viewed palliative care as appropriate for patients with end-stage dementia. Given the concentration of aging patients in the high-risk group, dementia as one test of the comprehensive geriatric assessment (CGAs), especially for older surgical patients, can predict postoperative outcomes 31 , and thus guide personalized approaches to medical care. Further, prescription of antipsychotic medications for dementia patients was associated with higher mortality rates 32 .…”

Section: Interpretation Of Predictorsmentioning

confidence: 99%

Assessing Statewide All-Cause Future One-Year Mortality: Prospective Study With Implications for Quality of Life, Resource Utilization, and Medical Futility (Preprint)

Yang¹,

Gang²,

Fu³

et al. 2018

Preprint

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1 Background: For many elderly patients, a "disproportionate" amount of health care resources and expenditures is spent during the last year of life, despite the discomfort and reduced quality of life associated with many aggressive medical approaches. However, few prognostic tools have focused on predicting all-cause one-year mortality among elderly patients at a statewide level, an issue that has implications for improving quality of life while distributing scarce resource fairly. Objective: Using data from a statewide elderly population (≥65 years old), we sought to validate prospectively an algorithm to identify patients at risk for dying in the future one year, for the purpose of minimizing decision uncertainty, improving quality of life, and reducing futile treatment. Methods: Analysis was performed using electronic medical records (EMRs) from the Health Information Exchange (HIE) in the state of Maine, which covered records of nearly 95% of the statewide population. The model was developed from 125,896 patients aged at least 65 years who were discharged from any care facility in the HIE network from September 5, 2013 to September 4, 2015. Validation was conducted using 153,199 patients with same inclusion and exclusion criteria from September 5, 2014 to September 4, 2016. Patients were stratified into risk groups. The association between all-cause one-year mortality and risk factors was screened by chi-squared test and manually reviewed by two clinicians. We calculated risk scores for individual patients using a gradient tree based boost algorithm, which measured the probability of mortality within the next 1 year based on the preceding one-year clinical profile. A total of 99 independent risk factors (n=99) for mortality were identified (reported as odds ratios; 95%CIs). Different tumor sites were recognized as driving risk factors, such as ovary (14.42; 2.24-53.04), colon (14.07; 10.08-19.08), stomach (13.64; 3.26-86.57), and bronchus/lung (12.38; 2.91-36.04). Disparities were also found in patients' social determinants like respiratory hazard index (1.24; 0.92-1.40), and unemployment rate (1.18; 0.98-1.24). Among high-risk patients who expired in our dataset, cerebrovascular accident, amputation, and type 1 diabetes were the top 3 diseases in terms of average cost in the last year of life. Conclusions: With statewide EMRs datasets, our study prospectively validated an accurate one-year risk prediction model and stratification for the elderly population (≥65 years old) at risk of mortality. It should be a valuable adjunct for helping patients to make better quality-of-life choices, and alerting care givers to target high-risk elderly for appropriate care and discussions, thus cutting back on futile treatment. Results

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Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk

Abstract: The multidimensional frailty score based on comprehensive geriatric assessment is more useful than conventional methods for predicting outcomes in geriatric patients undergoing surgery.

Cited by 344 publications

References 30 publications

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Patient-Specific Immune States Before Surgery Are Strong Correlates of Surgical Recovery

Assessing Statewide All-Cause Future One-Year Mortality: Prospective Study With Implications for Quality of Life, Resource Utilization, and Medical Futility (Preprint)

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