Simplified Frailty Index to Predict Adverse Outcomes and Mortality in Vascular Surgery Patients

Karam, Joseph A.; Tsiouris, Athanasios; Shepard, Alexander; Velanovich, Vic; Rubinfeld, Ilan

doi:10.1016/j.avsg.2012.09.015

Cited by 237 publications

(201 citation statements)

References 15 publications

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“…Frailty increases susceptibility to adverse health outcomes and contributes to the difference between chronological and physiological age 7. It is associated with increased mortality, surgical site infections, length of hospital stay, increased healthcare expenditure, and readmission rates in patients presenting for a variety of major noncardiac surgeries 8, 9, 10, 11, 12. Frailty has also been reported as a risk factor for mortality, major adverse cardiac and cerebrovascular events, and increased length of hospital stay in cardiac surgical patients 1, 2, 13, 14, 15, 16.…”

Section: Introductionmentioning

confidence: 99%

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

Tran

Dupuis

et al. 2018

JAHA

104

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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: Introductionmentioning

confidence: 99%

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

Tran

Dupuis

et al. 2018

JAHA

104

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“…One study considered both prevalent and incident delirium, following older patients admitted to mixed surgical wards daily for the first week, then every second day until discharge (29). They reported that delirium occurred in 11% of patients.…”

Section: Deliriummentioning

confidence: 99%

“…The study design varied and included twenty-two prospective studies, two retrospective studies and one cross-sectional study. Five of the included studies were sub-group analyses of larger studies (27)(28)(29)(30)(31). Several studies reported findings for more than one outcome (10,24,30,32,33).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Only one study (34) specifically reported on patients undergoing emergency and elective surgery. Five studies did not describe the acuity of surgery specifically (27,(29)(30)(31)35) -three of these were ward based studies of surgical patients and may have included a mixed group of elective and emergency patients.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Recent studies have reported a high prevalence of frailty in older surgical patients and identified that pre-operative frailty is an important predictor of poor discharge outcomes including longer hospital stays and the need for higher levels of care (24,25). However, there is limited evidence supporting interventions to improve discharge outcomes (26)(27)(28)(29). There is a clear need to understand the risk of geriatric syndromes and the relationship between frailty, geriatric syndromes and outcomes in both elective and non-elective older surgical ward patients in order to design intervention studies to improve these outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Understanding the occurrence of geriatric syndromes in older surgical patients

McRae¹

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The population is ageing and surgery is becoming more common as the treatment of choice for many diseases and conditions in older people. Although mortality rates are low for many operations, older patients are at increased risk of complications and may have poor outcomes including longer hospital stays and discharge to sub-acute care or aged care facilities.The aim of this thesis was to describe the occurrence of non-disease specific complications, known as geriatric syndromes, in older patients admitted to surgical wards, and to explore the association of 'frailty' and other key risk factors with geriatric syndromes and discharge outcomes in order to identify high risk groups who might benefit from interventions designed to prevent these complications and improve discharge outcomes.The specific aims were to:1. Describe the occurrence of geriatric syndromes in older surgical ward patients (with the exception of hip fracture or cardiothoracic patients) 2. Investigate the association between key risk factors for geriatric syndromes and discharge outcomes (acute length of stay and discharge destination) in older surgical ward patients.A literature review of the occurrence of geriatric syndromes in the broader surgical population cared for in usual care wards is presented in Chapter 2(1).The occurrence of geriatric syndromes in older patients admitted under two surgical subspecialty units is presented in Chapter 3 (2). In this retrospective cohort study of 112 patients aged 65, admitted under the urology or vascular surgical units of Royal Brisbane and Women's Hospital for three days or more, we found that geriatric syndromes occurred in 32 % of patients. We examined the association of pre-existing impairment in activities of daily living (a unidimensional marker of frailty), mode of admission (elective versus non-elective), extent of surgery (non-operative, minor, major) and surgical sub-specialty unit with ≥1 geriatric syndromes. In multivariable analysis, nonelective admission, major surgery and pre-existing impairment in activities of daily living increased the likelihood of geriatric syndromes. No significant association was seen in the adjusted model with surgical unit, age or comorbidity score.In Chapter 4, we describe the prevalence of frailty and the occurrence of geriatric syndromes in older vascular surgical ward patients and more precisely examine the association of pre-existing II patient factors (frailty and comorbidities), illness severity, surgical severity and mode of admission with ≥1 geriatric syndromes, acute length of stay and discharge destination from the vascular surgical unit. In a prospective cohort study of 110 patients admitted to the vascular surgical unit of Royal Brisbane and Women's Hospital for three days or more, we found that 39% of participants were frail and 36% developed ≥1 geriatric syndromes. In multivariable analysis, this study found multiple risk factors for geriatric syndromes; frailty and non-elective admission were important predictors for both geriatric syndrom...

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Assessment of the Predictive Value of the Modified Frailty Index for Clavien-Dindo Grade IV Critical Care Complications in Major Head and Neck Cancer Operations

Abt

Richmon

Koch

et al. 2016

JAMA Otolaryngol Head Neck Surg

105

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Simplified Frailty Index to Predict Adverse Outcomes and Mortality in Vascular Surgery Patients

Cited by 237 publications

References 15 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

Understanding the occurrence of geriatric syndromes in older surgical patients

Assessment of the Predictive Value of the Modified Frailty Index for Clavien-Dindo Grade IV Critical Care Complications in Major Head and Neck Cancer Operations

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