2020
DOI: 10.1001/jamasurg.2020.5152
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Association Between Patient Frailty and Postoperative Mortality Across Multiple Noncardiac Surgical Specialties

Abstract: IMPORTANCEFrailty is an important risk factor for postoperative mortality. Whether the association between frailty and mortality is consistent across all surgical specialties, especially those predominantly performing lower stress procedures, remains unknown.OBJECTIVE To examine the association between frailty and postoperative mortality across surgical specialties. DESIGN, SETTING, AND PARTICIPANTSA cohort study was conducted across 9 noncardiac specialties in hospitals participating in the American College o… Show more

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Cited by 92 publications
(121 citation statements)
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“…The incidence of emergency neurosurgery declined abruptly in patients above 85 years, which was somewhat unexpected since the incidence of TBI-related hospital admissions is highest for the eldest patients (21,34). Decisions to limit treatment are more often made for older patients (37,38), and for many of these patients, it is justi ed to refrain from emergency neurosurgery based on poor prognosis, severe comorbidity, and frailty (39,40). The use of age alone as a criterion for treatment limitation must be practiced with caution, since several studies have shown that older patients may bene t from aggressive treatment and access to rehabilitation (41)(42)(43)(44)(45)(46)(47).…”
Section: Discussionmentioning
confidence: 99%
“…The incidence of emergency neurosurgery declined abruptly in patients above 85 years, which was somewhat unexpected since the incidence of TBI-related hospital admissions is highest for the eldest patients (21,34). Decisions to limit treatment are more often made for older patients (37,38), and for many of these patients, it is justi ed to refrain from emergency neurosurgery based on poor prognosis, severe comorbidity, and frailty (39,40). The use of age alone as a criterion for treatment limitation must be practiced with caution, since several studies have shown that older patients may bene t from aggressive treatment and access to rehabilitation (41)(42)(43)(44)(45)(46)(47).…”
Section: Discussionmentioning
confidence: 99%
“…Surgical specialties were categorized from low to high intensity, and the relationship between frailty and mortality held even for low‐intensity specialties such as plastic surgery 9 . In vascular surgery, a high‐intensity specialty, a designation of “very frail” as measured by the Risk Analysis Index was closely associated with 30‐day mortality (adjusted OR = 12.66, 95% CI = 10.31–15.55) 10 . Similarly, another recent study retrospectively evaluated 1,341 older adults undergoing three types of major surgery from the Health and Retirement Study.…”
Section: Figurementioning
confidence: 99%
“…9 In vascular surgery, a high-intensity specialty, a designation of "very frail" as measured by the Risk Analysis Index was closely associated with 30-day mortality (adjusted OR = 12.66, 95% CI = 10.31-15.55). 10 Similarly, another recent study retrospectively evaluated 1,341 older adults undergoing three types of major surgery from the Health and Retirement Study. The study objective was to evaluate the association between several geriatric conditions (functional dependence, cognitive impairment, and depression) and 1-year mortality.…”
mentioning
confidence: 99%
“…On the other hand, the pre-operative detection of frailty is becoming more relevant in these older surgical patients. Frailty has been shown to be a good predictor of post-operative complications of major gastrointestinal procedures [3], and it has been associated with post-operative mortality across all noncardiac surgical specialties [4]. Additionally, frailty has a detrimental impact on costs and hospital pro t for elective surgery [5].…”
Section: Introductionmentioning
confidence: 99%