Standardised Frailty Indicator as Predictor for Postoperative Delirium after Vascular Surgery: A Prospective Cohort Study

Pol, Robert A.; Leeuwen, van; Visser, Linda; Izaks, Gerbrand J.; Dungen, van den Johannes; Tielliu, Ignace F.J.; Zeebregts, Clark J.

doi:10.1016/j.ejvs.2011.07.006

Cited by 109 publications

(96 citation statements)

References 27 publications

(17 reference statements)

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“…Incident data and audits of admission risk, performed in my clinical role, showed similar levels of risk of falls and pressure ulcers in older medical and surgical ward patients. Pilot studies at RBWH to reduce geriatric syndromes and improve outcomes in acute medical patients had shown promising results (30)(31)(32)(33). A better understanding of the occurrence of geriatric syndromes in older surgical ward patients would inform the potential for broader applicability of these interventions with vulnerable older surgical groups.…”

Section: The Settingmentioning

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%

“…Most studies (10,24,25,30,33) used the Geriatric Depression Score, although cut-off scores for depression were inconsistent between studies. The prevalence of depression ranged from 9 to 29%.…”

Section: Depressionmentioning

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%

“…The prevalence of depression ranged from 9 to 29%. In a crosssectional survey of 270 patients admitted to mixed surgical wards, 32% of patients were found to be depressed (30).…”

Section: Depressionmentioning

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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Section: The Settingmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Section: Depressionmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

“…The prevalence of depression ranged from 9 to 29%. In a crosssectional survey of 270 patients admitted to mixed surgical wards, 32% of patients were found to be depressed (30).…”

Section: Depressionmentioning

confidence: 99%

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Understanding the occurrence of geriatric syndromes in older surgical patients

McRae¹

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Estimating Risk of Postsurgical General and Geriatric Complications Using the VESPA Preoperative Tool

et al. 2017

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Predicting outcomes in older patients undergoing vascular surgery using the Hospital Frailty Risk Score

Aitken

Lujic

Randall³

et al. 2020

British Journal of Surgery

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Background Frailty may explain why some older patients having vascular surgery are at high risk of adverse outcomes. The Hospital Frailty Risk Score (HFRS) has been designed specifically for use with administrative data and has three categories of frailty risk (low, intermediate and high). The aim of this study was to evaluate the HFRS in predicting mortality, and hospital use in older patients undergoing vascular surgery. Methods Routinely collected hospital data linked to death records were analysed for all patients aged 75 years or older who had undergone either endovascular or open vascular surgery between 2010 and 2012 in New South Wales, Australia. Multilevel logistic regression models were used to compare outcomes adjusted for patient and procedural factors, with and without frailty. Results Some 9752 patients were identified, of whom 1719 (17·6 per cent) had a high-risk HFRS. Patients in the high-risk frailty category had an adjusted odds ratio for death by 30 days after surgery of 4·15 (95 per cent c.i. 2·99 to 5·76) compared with those in the low-risk frailty category, and a similarly increased odds of death by 2 years (odds ratio 4·27, 3·69 to 4·95). Adding the HFRS to a model adjusted for age, sex, co-morbidity score, socioeconomic status, previous hospitalization and vascular procedure type improved the prediction of 2-year mortality and prolonged hospital stay, but there was minimal improvement for 30-day mortality and readmission. Conclusion Adjusting for the HFRS in addition to other patient and procedural risk factors provided greater discrimination of outcomes in this cohort of older patients undergoing vascular surgery.

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Standardised Frailty Indicator as Predictor for Postoperative Delirium after Vascular Surgery: A Prospective Cohort Study

Abstract: The GFI can be helpful in the early identification of POD after vascular surgery in a select group of high-risk patients.

Cited by 109 publications

References 27 publications

Understanding the occurrence of geriatric syndromes in older surgical patients

Understanding the occurrence of geriatric syndromes in older surgical patients

Estimating Risk of Postsurgical General and Geriatric Complications Using the VESPA Preoperative Tool

Predicting outcomes in older patients undergoing vascular surgery using the Hospital Frailty Risk Score

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