Association of a Frailty Screening Initiative With Postoperative Survival at 30, 180, and 365 Days

Hall, Daniel E.; Arya, Shipra; Schmid, Kendra K.; Carlson, Mark A.; Lavedan, Pierre; Bailey, Travis L.; Purviance, Georgia; Bockman, Tammy; Lynch, Thomas G.; Johanning, Jason M.

doi:10.1001/jamasurg.2016.4219

Cited by 281 publications

(207 citation statements)

References 29 publications

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“…Other reports [27,29] have also witnessed this increasing challenge. Hopefully, by identifying frailty and optimizing treatment strategies with refined prognostication and multidisciplinary decision-making, we will in future be able to reduce postoperative morbidity and mortality [30].…”

Section: Discussionmentioning

confidence: 99%

Evolving Clinical Picture of Renal Cell Carcinoma: A Population-Based Study from Helsinki

et al. 2019

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Background: There is a lack of detailed population-based data for renal cell carcinoma (RCC). Objectives: The study aimed to examine the contemporary changes in the clinical picture and treatment of RCC. Methods: A total of 1,719 consecutive patients living in the Helsinki metropolitan area with a solid or cystic renal mass (Bosniak 3–4) ≥10 mm were identified. Data from medical records was evaluated for clinical characteristics and treatments in the periods I (2006–2008), II (2009–2011), III (2012–2014), and IV (2015–2016). Results: The proportions of patients with comorbidities (Charlson index ≥2) and frailty (Eastern Co-operative Oncology Group classification ≥2) increased significantly during the study period. The percentage of clinical stage I patients, cystic tumors and use of needle biopsies increased significantly. Use of observation increased from 9% (I) to 32% (IV; p < 0.001). First-line oncological treatments within 6 months were given to 47% of 262 patients with metastases and cytoreductive nephrectomy (CN) was delivered to 54% of those patients. Conclusions: The size of renal tumors continued to decrease, while the percentage of patients with significant comorbidity or frailty increased. Active surveillance emerged as the initial strategy. Tyrosine kinase inhibitors with CN remained the primary option in patients with metastatic RCC.

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Section: Discussionmentioning

confidence: 99%

Evolving Clinical Picture of Renal Cell Carcinoma: A Population-Based Study from Helsinki

et al. 2019

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“…29 In their study, patients with high RAI scores were flagged for administrative review and possible modification of surgical plans or preoperative optimization. 30 …”

Section: Discussionmentioning

confidence: 99%

An Accumulated Deficits Model Predicts Perioperative and Long-term Adverse Events after Carotid Endarterectomy

Sridharan¹,

Chaer²,

Wu³

et al. 2018

Annals of Vascular Surgery

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Background There is increasing recognition that decreased reserve in multiple organ systems, known as accumulated deficits (AD), may better stratify perioperative risk than traditional risk indices. We hypothesized that an AD model would predict both perioperative adverse events and long-term survival after carotid endarterectomy (CEA), particularly important in asymptomatic patients. Methods Consecutive patients undergoing CEA between 1st January 2000 and 31st December 2010 were retrospectively identified. Seven of the deficit items from the Canadian Study of Health and Aging–frailty index (coronary disease, renal insufficiency, pulmonary disease, peripheral vascular disease, heart failure, hypertension, and diabetes) were tabulated for each patient. Predictors of perioperative and long-term outcomes were evaluated using regression analysis. Results About 1,782 CEAs in 1,496 patients (mean age: 71.3 ± 9.3 years, 56.3% male, 35.4% symptomatic) were included. The risk of major adverse events (stroke, death, or myocardial infarction) at 30 days for patients with ≤3 deficits was 2.53% vs. 8.81% for patients with ≥4 deficits (P < 0.001). For patients with ≥5 deficits, the risk was 15.18%. Each additional deficit increased the odds of a 30-day major adverse event and hospital stay >2 days by 1.64 (P < 0.001) and 1.15 (P < 0.001), respectively. In multivariate analysis, the presence of ≥4 deficits was more predictive of perioperative major adverse events (odds ratio [OR] = 3.62, P < 0.001) than symptomatology within 6 months (OR = 1.57, P = 0.08) or octogenarian status (OR = 2.00, P = 0.02). Kaplan-Meier analysis showed significantly decreased survival over time with accumulating deficits (P < 0.001). Patients with ≥4 deficits have a hazards ratio for death of 2.6 compared to patients with ≤3 deficits (P < 0.001). Overall survival is estimated at 79.5% (95% confidence interval [CI]: 0.77–0.82) at 5 years in patients with ≤3 deficits versus 52.4% (95% CI: 0.46–0.58) in patients with ≥4 deficits, respectively. In subgroup analysis of asymptomatic patients, 5-year survival for octogenarian male patients with ≥4 deficits was only 26.8%. For asymptomatic males aged 70–79 years with ≥4 deficits, 5-year survival was 59.9%. Conclusions An AD model is more predictive of perioperative adverse events after CEA than age or symptomatic status. This model remains predictive of long-term survival. In asymptomatic male octogenarians with 4 or more AD, 5-year survival is severely limited.

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“…29 In their study, patients with high RAI scores were flagged for administrative review and possible modification of surgical plans or preoperative optimization. 30 For many conditions, less invasive approaches or nonsurgical management may not be feasible. However, carotid disease provides a unique pathology with multiple treatment modalities (open surgical, endovascular, and medical) where frailty screening may actually shape management.…”

Section: Discussionmentioning

confidence: 99%

An Accumulated Deficits Model Predicts Perioperative and Long-Term Adverse Events After Carotid Endarterectomy

Sridharan

Chaer

et al. 2017

Annals of Vascular Surgery

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Association of a Frailty Screening Initiative With Postoperative Survival at 30, 180, and 365 Days

Cited by 281 publications

References 29 publications

Evolving Clinical Picture of Renal Cell Carcinoma: A Population-Based Study from Helsinki

Evolving Clinical Picture of Renal Cell Carcinoma: A Population-Based Study from Helsinki

An Accumulated Deficits Model Predicts Perioperative and Long-term Adverse Events after Carotid Endarterectomy

An Accumulated Deficits Model Predicts Perioperative and Long-Term Adverse Events After Carotid Endarterectomy

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