Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations

Seib, Carolyn D.; Rochefort, Holly; Chomsky-Higgins, Kathryn; Gosnell, Jessica E.; Suh, Insoo; Shen, Wen T.; Duh, Quan‐Yang; Finlayson, Emily

doi:10.1001/jamasurg.2017.4007

Cited by 153 publications

(109 citation statements)

References 67 publications

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“…a reduced physiologic reserve, is an emerging concept across the surgical literature that aims to elucidate the differential effects of age versus the cumulative effect of multiple comorbidities on surgical outcomes. While frailty, as most often measured by the modified frailty index (mFI-11), has been associated with poorer neurosurgical outcomes, its effect among those with cSDH is unclear [ 3 - 6 ]. To date, no study has compared the effect of frailty versus iGCS for predicting outcomes in both operative and non-operative cSDH.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

McIntyre

Rawanduzy

Afridi

et al. 2020

Cureus

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Background Initial Glasgow Coma Score (iGCS) is a well-known predictor of adverse outcomes following chronic subdural hemorrhage (cSDH). Frailty, i.e. a reduced physiologic reserve, is associated with poorer outcomes across the surgical literature, however, there is no consensus on the best measure of frailty. To date, no study has compared frailty’s ability to predict cSDH outcomes versus iGCS. The goal of this study was to, therefore, examine the prognostic value of the 5- (mFI-5) and 11-factor (mFI-11) modified frailty index, and Charlson Comorbidity Index (CCI) versus iGCS following cSDH. Methods Between January, 2016 and June, 2018, patients who presented to the emergency department with cSDH were retrospectively identified using the International Classification of Diseases (ICD) codes. mFI-5, mFI-11, and CCI scores were calculated using patient baseline characteristics. Primary endpoints were death and discharge home and subgroup analyses were performed among operative cSDH. Univariate and multivariate logistic regressions were used to determine predictors of primary endpoints. Results Of the 109 patients identified, the average age was 72.6±1.6 years and the majority (69/109, 63.3%) were male. The average CCI, mFI-5, and mFI-11 were 4.5 ±0.2, 1.5 ±0.1, and 2.2 ±0.1, respectively. Fifty (45.9%) patients required surgical intervention, 11 (10.1%) died, and 48 (43.4%) were discharged home. In the overall cohort, while the only multivariate predictor of mortality was iGCS (OR=0.58; 95%CI:0.44-0.77; p=0.0001), the CCI (OR=0.73; 95%CI:0.58-0.92; p=0.0082) was a superior predictor of discharge home compared to iGCS (OR=1.46; 95%CI:1.13-1.90; p=0.0041). Conversely, among those who received an operative intervention, the CCI, but not iGCS, independently predicted both mortality (OR=4.24; 95%CI:1.01-17.86; p=0.0491) and discharge home (OR=0.55; 95%CI:0.33-0.90; p=0.0170). Neither mFI nor age predicted primary outcomes in multivariate analysis. Conclusion While frailty is associated with worse surgical outcomes, the clinical utility of the mFI-5, mFI-11, and CCI in cSDH is unclear. We show that the iGCS is an overall superior predictor of mortality following cSDH but is outperformed by the CCI after operative intervention. Similarly, the CCI is the superior predictor of discharge home in cSDH patients overall and following an operative intervention. These results indicate that while the iGCS best predicts mortality overall, the CCI may be considered when prognosticating post-operative course and hospital disposition.

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Section: Introductionmentioning

confidence: 99%

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

McIntyre

Rawanduzy

Afridi

et al. 2020

Cureus

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“…Trotz vieler Vorteile eines ambulanten Vorgehens bergen die Anästhesie und Operation des älteren Patienten zahlreiche Gefahren. Nach einer aktuellen Untersuchung sind die unter "Info -Risikofaktoren" genannten Faktoren mit einer erhöhten Morbidität nach ambulanter Allgemeinanästhesie assoziiert [10]. Das Risiko für schwere Komplikationen ist bereits doppelt so hoch, wenn 2-3 der genannten Faktoren vorliegen, bei ≥ 4 Faktoren sogar 4mal so hoch.…”

Section: Kategorieunclassified

Obere Altersgrenze bei ambulanter Anästhesie: Möglichkeiten und Risiken

Hüppe¹,

Kneller²,

Raddatz³

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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Ambulatory surgery in elderly patients continues to increase - avoiding hospitalization and thus postoperative cognitive dysfunction in older patients being its major objectives. An upper age limit in outpatient anesthesia does not exist to date. However, functional rather than chronological age is crucial in patient selection. In consensus discussion, baseline functional status should be evaluated regularly - defined as everyday behaviors necessary to maintain daily life and encompassing areas of physical, cognitive, and social functioning. Moreover, frailty in elderly patients can be quantified objectively and is associated with increased perioperative morbidity in ambulatory general surgery. The decision for or against outpatient anesthesia therefore remains a case-by-case decision which should be discussed within a team.

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“…Prior studies have investigated the effects of frailty on patients undergoing surgery for a broad range of thyroid disease [14][15][16]. Frailty was more predictive of postthyroidectomy systemic complications than age in older adults with multimodal goiter [14].…”

Section: Introductionmentioning

confidence: 99%

Impact of frailty on inpatient outcomes in thyroid cancer surgery: 10-year results from the U.S. national inpatient sample

Fei

Lai

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Background: Frailty is linked to perioperative morbidity and mortality. We evaluated the impact of preoperative frailty on inpatient outcomes of patients undergoing surgery for thyroid malignancy. Methods: This population-based, retrospective observational study extracted data of hospitalized patients who were 18 years and older with a primary diagnosis of thyroid cancer undergoing thyroidectomy from the US Nationwide Inpatient Sample (NIS) database (2005-2014). Participants were stratified into frail and non-frail using the Johns Hopkins (ACG) frailty-defining diagnosis indicator. Study endpoints were in-hospital mortality, incidence of surgical and medical complications and prolonged length of stay. Univariate and multivariate analysis were performed to determine associations between the endpoints and frailty. Results: Data of 38,202 patients were included. After adjusting for possible confounders, frailty remained significantly associated with higher odds of in-hospital mortality (OR: 3.839, 95% CI: 1.738-8.480), prolonged length of stay (OR: 5.420, 95% CI: 3.799-7.733), surgical complications (OR: 3.144, 95% CI: 2.443-4.045) and medical complications (OR: 6.734, 95% CI: 5.099-8.893) compared with non-frailty. In patients > age 65 years, adjusted odds ratio for frailty was 4.099 (95% CI: 1.736-9.679) for in-hospital mortality, 6.164 (95% CI: 3.514-10.812) for prolonged length of stay, 3.736 (95% CI: 2.620-5.328) for surgical complications, and 5.970, 95% CI: 4.088-8.720 for medical complications, all with significance. Conclusion: Frailty is associated with increased risk for adverse inpatient outcomes, including prolonged hospital stay, surgical and medical complications and mortality independent of age and comorbidities in thyroid cancer patients undergoing surgery. Study findings may provide valuable information for preoperative risk stratification.

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Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations

Cited by 153 publications

References 67 publications

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

Obere Altersgrenze bei ambulanter Anästhesie: Möglichkeiten und Risiken

Impact of frailty on inpatient outcomes in thyroid cancer surgery: 10-year results from the U.S. national inpatient sample

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