Are the frail destined to fail?: Frailty index as a predictor of surgical morbidity and mortality in the elderly

Farhat, Joseph; Falvo, Anthony; Horst, H. Mathilda; Swartz, Andrew; Velanovich, Vic; Patton, Joe H.; Rubinfeld, Ilan

doi:10.1016/j.jamcollsurg.2011.06.147

Cited by 93 publications

(156 citation statements)

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“…One study noted, following testing of baseline cognitive status, that that there were no patients with cognitive impairment (37). Three studies did not exclude participants with cognitive impairment, but either did not describe this element specifically (27,31) or it could not be extracted because the study was a subgroup analysis of a larger study (28).…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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%

“…A retrospective study investigated postoperative falls in an orthopaedic ward which predominantly admitted elective patients for hip and knee arthroplasty and found that 2% of patients fell (27). A higher incidence of falls (6%) was reported in a prospective study which examined the frequency of falls from admission to discharge in patients admitted to mixed surgical wards (31).…”

Section: Fallsmentioning

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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