No abstract

Background The modified frailty index (mFI-11) is a National Surgical Quality Improvement Program (NSQIP)–based 11-factor index that has been proven to adequately reflect frailty and predict mortality and morbidity. In the past years, certain NSQIP variables have been removed from the database; as of 2015, only 5 out of the original 11 factors remain. While the predictive power and usefulness of this 5-factor index (mFI-5) has been proven in previous work, it has yet to be studied in the geriatrics population. The goal of our study was to compare the mFI-5 to the mFI-11 in terms of value and predictive ability for mortality, postoperative infection, and unplanned 30-day readmission for patients aged 65 years and older. Methods Spearman’s Rho was calculated to compare the value, and unadjusted and adjusted logistic regressions were created for three outcomes in nine surgical subspecialties. Correlation coefficients were above .86 across all surgical specialties except for cardiac surgery. Adjusted and unadjusted models showed similar C-statistics for mFI-5 and 11. Results Overall predictive values of geriatric mFI-5 and mFI-11 were lower than those for the general population but still had effective predictive value for mortality and post-operative complications (C-Stat ≥ .7) and weak predictive value for 30-day readmission. Conclusions The mFI-5 is an equally effective predictor as the mFI-11 in all subspecialties and an effective predictor of mortality and postoperative complication in the geriatric population. This index has credibility for future use to study frailty within NSQIP, within other databases, and for clinical assessment and use.

The distribution of the novel Covid-19 vaccines has been on a scale as unprecedented as the pandemic itself. While the vaccines promise to greatly reduce the spread and impact of the disease, encountering side-effects in clinical practice may pose diagnostic dilemmas. In this case report, we describe a patient with known metastatic renal cell carcinoma who presents with axillary lymphadenopathy found on PET/CT imaging after receiving a Covid-19 vaccine, which was subsequently confirmed to be reactive lymphadenopathy following biopsy.

Drain placement after major hepatectomy may lead to increased postoperative complications including bile leak, superficial surgical site infection, and hospital length of stay and does not decrease the need for secondary procedures in patients with bile leaks.

Objective: To determine the association between PPOU and the longterm risk of OUD and opioid overdose. Summary Background Data: PPOU is a commonly used outcome in the surgical literature; its incidence and risk factors have been well described. However, its association to long term outcomes, including OUD and opioid overdose, is unknown. Methods: A retrospective cohort study utilizing the Veterans Health Administration corporate data warehouse. Patients undergoing any surgery between January 1, 2008 and December 31, 2018 were included and followed until December 31, 2020. Univariate and multivariate survival analysis were used to determine the association between PPOU and OUD and overdose. Sensitivity analyses were conducted to determine the impact of different definitions of persistent opioid use and the effect of preoperative opioid use. Results: A total of 344,745 patients undergoing surgery were included and followed for a median of 6.18 years (IQR 3.53-9.12). PPOU was associated with an increased hazard of developing both OUD (HR = 1.88, CI: 1.81-1.95, P < 0.001) and overdose (HR = 1.83, CI: 1.72-1.94, P < 0.001). This association remained consistent after adjustment for comorbidities and across all sensitivity analyses. Conclusions: Surgical patients who develop PPOU are at increased risk of both OUD and overdose as compared to surgical patients who do not develop persistent use.