Adapting the Vulnerable Elders Survey‐13 to Predict Mortality Using Responses to the Medicare Health Outcomes Survey

Beckett, Megan K.; Elliott, Marc N.; Ritenour, Douglas; Giordano, Laura; Grace, Susan; Malinoff, Rochelle; Saliba, Debra

doi:10.1111/jgs.14734

Cited by 5 publications

(1 citation statement)

References 17 publications

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“…Many individual assessment tools have been constructed to quantify frailty, including the Edmonton FRAIL scale, the Vulnerability Elders Survey-13, the Johns Hopkins ACG frailty-defining diagnosis indicator, 16 the G-8 questionnaire, 17,37 the Comprehensive Geriatric Assessment, the Groningen Frailty Indicator, the Phenotype model, and the Frailty Index. 4,5,[38][39][40][41] Two of these models of frailty assessment, the Phenotype model and Frailty Index, were endorsed by the American College of Surgeons and commonly used to assess elderly patients preoperatively. 4,5 While these models both served as important indices to identify high-risk surgical patients, they both required time beyond an initial preoperative assessment.…”

Section: Discussionmentioning

confidence: 99%

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

Goshtasbi

Birkenbeuel

Lehrich

et al. 2021

Otolaryngol.--head neck surg.

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Objectives To evaluate the impact of preoperative frailty on short-term outcomes following complex head and neck surgeries (HNSs). Study Design Cross-sectional database analysis. Setting American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Methods The 2005 to 2017 ACS-NSQIP was queried for patients undergoing complex HNS. Five-item modified frailty index (mFI) was calculated based on functional status and history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and chronic hypertension. Results A total of 2786 patients (73.1% male) with a mean age of 62.0 ± 11.6 years were included. Compared to nonfrail patients (41.2%), patients with mFI ≥1 (58.8%) had shorter length of operation ( P = .021), longer length of stay (LOS) ( P < .001), and higher rates of 30-day reoperation ( P = .009), medical complications ( P < .001), discharge to nonhome facility (DNHF) ( P < .001), and mortality ( P = .047). These parameters remained statistically significant when compared across all individual mFI scores (all P < .05). After adjusting for age, sex, race, body mass index, smoking, and American Society of Anesthesiologists score via multivariate logistic regression, patients with mFI ≥1 were significantly more likely to undergo reoperation (odds ratio [OR], 1.39), surgical complications (OR, 1.19), medical complications (OR, 1.55), prolonged LOS (OR, 1.29), and DNHF (OR, 1.56) (all P < .05). Multivariate logistic regression also demonstrated that after adjusting for confounders, compared to patients with mFI = 1, patients with mFI = 2-5 (18.7%) were more likely to undergo shorter operations (OR, 0.74), have medical (OR, 1.46) or any complications (OR, 1.27), and have DNHF (OR, 1.62) (all P < .05). Conclusion The 5-point mFI can independently predict short-term surgical outcomes following complex HNS. This simple and reliable metric can potentially lead to improved preoperative counseling and postoperative planning for complex HNS patients.

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Section: Discussionmentioning

confidence: 99%

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

Goshtasbi

Birkenbeuel

Lehrich

et al. 2021

Otolaryngol.--head neck surg.

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Long-Term Functional Decline Following Vascular Surgery Among Vulnerable Adults

DeAngelo

Peacock

Holeman

et al. 2021

Annals of Vascular Surgery

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Love and frailty and an avalanche of missteps

Balducci

2024

J American Geriatrics Society

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A retired oncologist describes the unexpected death of his wife, Claudia, who spent 25 years as head of the geriatrics service of a major VA hospital. The couple drew comfort in their orchestration of a “good death”; nevertheless they understood that her death was hastened by a number of missteps. In the 2 months following a hip fracture, a chain of complications that required five surgical interventions led to massive hemorrhage from necrotizing esophagitis. Claudia lacked resilience to recover from a sequence of traumas sustainable by a younger person—but even the most experienced geriatrician might not have identified or even suspected her risk. Despite multiple well‐controlled comorbidities Claudia was active and independent. She exercised daily and traveled extensively. She did not fit the profile of a frail or vulnerable person, according to assessing instruments in current use. According to the e‐prognosis calculator, her mortality risk was 10% lower than that of women her age. It is not surprising, nor deplorable, that after Claudia developed mild dysphagia, a gastroenterologist put off an EGD, awaiting a cardiac consult. That delay, however, proved fatal. Had the procedure been performed as soon as possible, it would have revealed esophagitis caused by a hiatal hernia, signaling need for different medications and prompt treatment. This might have prevented the terminal hemorrhage. The first important lesson from this case is that for an older patient with multiple comorbidities, even under control, delayed treatment is treatment denied. Current evaluation instruments are unable to spot critical resilience reductions in functional seniors. Inadequate pain management, premature discharge after surgery, and poor communication also contributed to the death. The second important lesson is that older patients, even when they are medical doctors, would benefit from a trained advocate to help them navigate the medical system.

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Adapting the Vulnerable Elders Survey‐13 to Predict Mortality Using Responses to the Medicare Health Outcomes Survey

Abstract: The VES-13 algorithm is robust to substitution of functional items and can be used to identify very high-risk older adults. Multiple imputation of missing items reduces loss-to-follow-up bias and increases sample size.

Cited by 5 publications

References 17 publications

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

Long-Term Functional Decline Following Vascular Surgery Among Vulnerable Adults

Love and frailty and an avalanche of missteps

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