The 5-Item Modified Frailty Index Predicts Adverse Outcomes in Trauma

Tracy, Brett M.; Wilson, Jacob M.; Smith, Randi N.; Schenker, Mara L.; Gelbard, Rondi B.

doi:10.1016/j.jss.2020.03.052

Cited by 59 publications

(50 citation statements)

References 24 publications

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“…Although this study did not specifically examine frailty, AD+ patients had a higher rate of CHF, COPD, CVA, and functional dependence. These variables are frequently used to evaluate frailty status and frailty has been shown to predict adverse outcomes in elderly patients 19–22 . Further study is needed to explore the impact of frailty on AD completion and patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Withdrawal of care may be driven by several factors, including the severity of injury, futility of care, [18][19][20] underlying comorbidities, 18,21 and family wishes and beliefs. 20,21 Palliative care specialists can help facilitate goals of care and family discussion that may ultimately lead to WOC. 20,21 Patients who received a PCC had a longer hospital stay prior to death and the median time from admission to PCC was 3 days.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who underwent WOC had a higher rate of functional dependence and were more severely injured, as indicated by a higher median ISS and a lower rate of admission GCS score of 15. Withdrawal of care may be driven by several factors, including the severity of injury, futility of care, [18][19][20] underlying comorbidities, 18,21 and family wishes and beliefs. 20,21 Palliative care specialists can help facilitate goals of care and family discussion that may ultimately lead to WOC.…”

Section: Discussionmentioning

confidence: 99%

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The patient’s voice matters: The impact of advance directives on elderly trauma patients

Lee

Khan

Dorlac

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Geriatric trauma rates are increasing, yet trauma centers often struggle to provide autonomy regarding decision making to these patients. Advance care planning can assist with this process. Currently, there are limited data on the impact of advance directives (ADs) in elderly trauma patients. The purpose of this study was to evaluate the prevalence of preinjury AD in geriatric trauma patients and its impact on outcomes, with the hypothesis that ADs would not be associated with an increase in mortality. METHODS:A multicenter retrospective review was conducted on patients older than 65 years with traumatic injury between 2017 and 2019. Three Level I trauma centers and one Level II trauma center were included. Exclusion criteria were readmission, burn injury, transfer to another facility, discharge from emergency department, and mortality prior to being admitted. RESULTS:There were 6,135 patients identified; 751 (12.2%) had a preinjury AD. Patients in the AD+ group were older (86 vs. 77 years, p < 0.0001), more likely to be women (67.0% vs. 54.8%, p < 0.0001), and had more comorbidities. Hospital length of stay and ventilator days were similar. In-hospital mortality occurred in 236 patients, and 75.4% of them underwent withdrawal of care (WOC). The mortality rate was higher in AD+ group (10.5% vs. 2.9%, p < 0.0001). No difference was seen in the rate of AD between the WOC+ and WOC-group (31.5% vs. 39.6%, p = 0.251). A preinjury AD was identified as an independent predictor of mortality, but not a predictor of WOC. CONCLUSION:Despite a high WOC rate in patients older than 65 years, most patients did not have an AD prior to injury. As the elderly trauma population grows, advance care planning should be better integrated into geriatric care to encourage a patient-centered approach to end-of-life care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The patient’s voice matters: The impact of advance directives on elderly trauma patients

Lee

Khan

Dorlac

et al. 2021

J Trauma Acute Care Surg

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“…Furthermore, the American Society of Anesthesiologists (ASA) class was recorded, and the Boey score and the Mannheim Peritonitis Index (MPI) were also calculated. Frailty was assessed by calculating the 5 modified Frailty Index (5-mFI) as described by Tracy et al 35 The primary aim of the present subset study was to critically appraise the treatment of peptic ulcer perforation in the elderly using the simple repair with or without omental patch. Patients were selected from the dataset using the International Classification of Diseases versions 9 (ICD-9) (diagnosis code 531.xx to 534.xx and afterwards filtered for operative code 44.40 to 44.42 or for 44.6×).…”

Section: Patient Characteristics Preoperative Variables and Objective...mentioning

confidence: 99%

Laparoscopic Repair of Perforated Peptic Ulcer in the Elderly: An Interim Analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study

Fransvea

Costa

Lepre

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Introduction:The number of elderly patients requiring emergency surgical intervention has increased dramatically. Perforated peptic ulcer (PPU) complications, such as perforation, have remained relatively stable and associated morbidity remains between 10% and 20%. Advances in perioperative care have greatly improved the outcomes of laparoscopic emergency surgery, allowing increasing numbers of patients, even the elderly, to undergo safe repair. The aim of this study was to evaluate the feasibility, safety, and outcome of laparoscopic gastric repair in the elderly using the database of the FRAILESEL (Frailty and Emergency Surgery in the Elderly) study.Materials and Methods: This is a retrospective analysis carried out on data of the FRAILESEL study. Data on all the elderly patients who underwent emergency abdominal surgery for PPU from January 2017 to December 2017 at 36 Italian surgical departments were analyzed. Patients who underwent PPU repair were further divided into a laparoscopic gastroduodenal repair (LGR) cohort and an open gastroduodenal repair (OGR) cohort, and the clinicopathologic features of the patients in both the groups were compared.Results: Sixty-seven patients fulfilled the inclusion criteria. Thirtythree patients (47.8%) underwent LGR. The LGR patients had less blood loss and shorter postoperative stay, even if the difference was not statistically significant. The mean operative time was significantively higher in the OGR (OGR 96.5 ± 27.7 vs. LGR 78.6 ± 16.3 P = 0.000). The rate of death after laparoscopic surgery was similar to the rate of the open surgery. Multivariate analysis indicated that only age (P = 0.018), admission haemoblogbin (Hb) level (P = 0.006), platelet count (P = 0.16), lactate level (P = 0.47), and Mannheim Peritonitis Index (P = 0.18) were independent variables associated with the risk of overall mortality. Conclusions:LGR is safe and feasible in elderly patients with PPU and it is associated with better perioperative outcomes. However, patient selection and preoperative frailty evaluation in the elderly population are the key to achieving better outcomes.

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“…Preoperative risk was assessed with anesthesiologist-assigned American Society of Anesthesiologists (ASA) class. Frailty was assessed by calculating the 5 modi ed Frailty Index (5-mFI) as described by Tracy et al (26) The Mannheim Peritonitis Index (MPI) was also calculated. (27) Systemic in ammatory response syndrome (SIRS) and quick-Sofa (q-Sofa) were also evaluated.…”

Section: Patients Characteristics Preoperative Variables and Objectives Of This Studymentioning

confidence: 99%

Clinical-pathological features and treatment of acute appendicitis in the very elderly: an interim analysis of the FRAILESEL Italian multicentre prospective study

Fransvea

Fico

Cozza

et al. 2021

Eur J Trauma Emerg Surg

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Background emergency abdominal surgery in the elderly represents a global issue. Diagnosis of AA in old patients is often more di cult. Appendectomy remains the gold standard of treatment and, even though it is performed almost exclusively with a minimally invasive technique, it can still represent a great risk for the elderly patient, especially above 80 years of age. A careful selection of elderly patients to be directed to surgery is therefore fundamental. The primary aim was to critically appraise and compare the clinical-pathological characteristics and the outcomes between oldest old (≥ 80 years) and elderly (65-79 years) patients with Acute Appendicitis (AA). MethodsThe FRAILESEL is a large, nationwide, multicenter, prospective study investigating the perioperative outcomes of patients aged ≥ 65 years who underwent emergency abdominal surgery. Particular focus has been directed to the clinical and biochemical presentation as well as to the need for operative procedures, type of surgical approach, morbidity and mortality, and in-hospital length of stay. Two multivariate logistic regression analyses were performed to assess perioperative risk factors for morbidity and mortality. Results182 patients ful lled the inclusions criteria. Mean age, ileocecal resection, OAD and ASA score ≥ 3 were related with both overall and major complication. The multivariate analysis showed that MPI and complicated appendicitis were independently factors associated with overall complications. OAD and ASA score ≥ 3 were independently factors for both overall and major complications. Conclusionsage ≥ 80 years is not an independent risk factor for morbidities. POCUS is safe and effective for the diagnosis; however, a CECT is often needed Having the oldest old a smaller functional organ reserve, an earlier intervention is needed, especially because they required greater rate of major resection.

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The 5-Item Modified Frailty Index Predicts Adverse Outcomes in Trauma

Cited by 59 publications

References 24 publications

The patient’s voice matters: The impact of advance directives on elderly trauma patients

The patient’s voice matters: The impact of advance directives on elderly trauma patients

Laparoscopic Repair of Perforated Peptic Ulcer in the Elderly: An Interim Analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study

Clinical-pathological features and treatment of acute appendicitis in the very elderly: an interim analysis of the FRAILESEL Italian multicentre prospective study

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