Clinical Utility of the Risk Analysis Index as a Prospective Frailty Screening Tool within a Multi-practice, Multi-hospital Integrated Healthcare System

Varley, Patrick; Borrebach, Jeffrey D.; Arya, Shipra; Massarweh, Nader N.; Bilderback, Andrew; Wisniewski, Mary Kay; Nelson, Joel B.; Johnson, Jonas T.; Johanning, Jason M.; Hall, Daniel E.

doi:10.1097/sla.0000000000003808

Cited by 73 publications

(94 citation statements)

References 31 publications

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“…39,40 By comparison, preoperative frailty screening using validated instruments has been found both efficient and effective for identifying potentially vulnerable adults and such tools are also being developed in pediatric patients. [41][42][43] As such, more objective preoperative assessment tools should be developed and used to aid the preoperative identification of patients who may be at risk for adverse postoperative outcomes, like FTR. There are several limitations to consider when interpreting our data.…”

Section: Discussionmentioning

confidence: 99%

Complications and Failure to Rescue After Inpatient Pediatric Surgery

et al. 2020

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Objective: To describe the frequency and patterns of postoperative complications and FTR after inpatient pediatric surgical procedures and to evaluate the association between number of complications and FTR. Summary and Background: FTR, or a postoperative death after a complication, is currently a nationally endorsed quality measure for adults. Although it is a contributing factor to variation in mortality, relatively little is known about FTR after pediatric surgery. Methods: Cohort study of 200,554 patients within the National Surgical Quality Improvement Program-Pediatric database (2012-2016) who underwent a high (≥ 1%) or low ( < 1%) mortality risk inpatient surgical procedures. Patients were stratified based on number of postoperative complications (0, 1, 2, or ≥3) and further categorized as having undergone either a low-or high-risk procedure. The association between the number of postoperative complications and FTR was evaluated with multivariable logistic regression. Results: Among patients who underwent a low-(89.4%) or high-risk (10.6%) procedures, 14.0% and 12.5% had at least 1 postoperative complication, respectively. FTR rates after low-and high-risk procedures demonstrated step-wise increases as the number of complications accrued (eg, low-risk-9.2% in patients with ≥3 complications; high-risk-36.9% in patients with ≥ 3 complications). Relative to patients who had no complications, there was a dose-response relationship between mortality and the number of complications after low-risk [1 complicationodds ratio (OR) 3.34 (95% CI 2.62-4.27); 2 -OR 10.15 (95% CI 7.40-13.92); ] and high-risk operations ≥3 )].Conclusions: There is a dose-response relationship between the number of postoperative complications after inpatient surgery and FTR, ever after common, "minor" surgical procedures. These findings suggest FTR may be a potential quality measure for pediatric surgical care.

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Section: Discussionmentioning

confidence: 99%

Complications and Failure to Rescue After Inpatient Pediatric Surgery

et al. 2020

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“…Brief survey instruments, such as the 14-item Risk Analysis Index (RAI), have shown encouraging prognostic ability with respect to mortality and post-operative complications. 13,16 Automated approaches to risk stratification leveraging the Electronic Health Record (EHR) are still desirable for two reasons. First, survey instruments like the RAI are currently performed after referral for surgery, and so are less useful for shared decision-making concerning whether or not to refer to surgery.…”

Section: Introductionmentioning

confidence: 99%

Automated Frailty Screening At‐Scale for Pre‐Operative Risk Stratification Using the Electronic Frailty Index

Callahan

Clark

Edwards

et al. 2021

J American Geriatrics Society

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BACKGROUND: Frailty is associated with numerous post-operative adverse outcomes in older adults. Current pre-operative frailty screening tools require additional data collection or objective assessments, adding expense and limiting large-scale implementation. OBJECTIVE: To evaluate the association of an automated measure of frailty integrated within the Electronic Health Record (EHR) with post-operative outcomes for nonemergency surgeries. DESIGN: Retrospective cohort study. SETTING: Academic Medical Center. PARTICIPANTS: Patients 65 years or older that underwent nonemergency surgery with an inpatient stay 24 hours or more between October 8th, 2017 and June 1st, 2019.EXPOSURES: Frailty as measured by a 54-item electronic frailty index (eFI). OUTCOMES AND MEASUREMENTS: Inpatient length of stay, requirements for post-acute care, 30-day readmission, and 6-month all-cause mortality. RESULTS: Of 4,831 unique patients (2,281 females (47.3%); mean (SD) age, 73.2 (5.9) years), 4,143 (85.7%) had sufficient EHR data to calculate the eFI, with 15.1% categorized as frail (eFI > 0.21) and 50.9% pre-frail (0.10 < eFI ≤ 0.21). For all outcomes, there was a generally a gradation of risk with higher eFI scores. For example, adjusting for age, sex, race/ ethnicity, and American Society of Anesthesiologists class, and accounting for variability by service line, patients identified as frail based on the eFI, compared to fit patients, had greater needs for post-acute care (odds ratio (OR) = 1.68; 95% confidence interval (CI) = 1.36-2.08), higher rates of 30-day readmission (hazard ratio (HR) = 2.46; 95%CI = 1.72-3.52) and higher all-cause mortality (HR = 2.86; 95%CI = 1.84-4.44) over 6 months' follow-up. CONCLUSIONS: The eFI, an automated digital marker for frailty integrated within the EHR, can facilitate preoperative frailty screening at scale.

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“…[12][13][14] Skin cancer excisions do not typically require general anesthesia, deep sedation, or large fluid shifts; however, studies have found that when frail patients undergo low-risk procedures, they tend to have a higher mortality rate than their healthier counterparts. 15 Frailty is a concept that identifies patients who are at increased risk of dying in 6 to 60 months due to a decline in their physical reserve. Frail patients have increased rates of perioperative mortality and complications.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Nonmelanoma Skin Cancer in Older Adult Veterans

Coady-Fariborzian¹

2022

Federal Practitioner

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Background: Older adult patients are frequently referred to surgical services for the treatment of nonmelanoma skin cancer (NMSC). The appropriateness of offering surgery to patients with serious comorbidities and a limited life expectancy has been questioned in the literature. The purpose of this study was to determine the morbidity and 5-year mortality for patients with NMSC referred to the plastic surgery service. Methods: A retrospective chart review was performed from July 1, 2011, to June 30, 2015, of all plastic surgery service consults for the treatment of NMSC. We collected the following data: age and life-limiting comorbidities at the time of referral, treatment, complications, and 5-year mortality. A χ 2 analysis was used to determine the statistical significance (P < .05) between the individual risk factors and 5-year mortality. The relative risk of 5-year mortality was calculated combining advanced age with individual comorbidities. Results: The plastic surgery service completed 800 consults for NMSC over a 4-year period. Five-year mortality was 28.6%. Median age of patients deceased at 5 years was 78 years at the time of the consult submission. The surgical complication rate was 5%. Aged ≥ 80 years, coronary artery disease, congestive heart failure, cerebral vascular disease, peripheral vascular disease, dementia, chronic kidney disease, chronic obstructive pulmonary disease, and diabetes mellitus were found individually to be statistically significant predictors of 5-year mortality. Combining aged ≥ 80 years, coronary artery disease, congestive heart failure, or dementia increased the 5-year mortality to a relative risk > 3. Conclusions: Surgical excision of NMSC in older adult patients is indicated in most situations. A frank discussion with the patient and caregiver is suggested. Surgical treatment of NMSC in older adult patients has a low morbidity but needs to be balanced against a patient's quality of life when they present with life-limiting comorbidities.

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Clinical Utility of the Risk Analysis Index as a Prospective Frailty Screening Tool within a Multi-practice, Multi-hospital Integrated Healthcare System

Abstract: Supplemental Digital Content is available in the text

Cited by 73 publications

References 31 publications

Complications and Failure to Rescue After Inpatient Pediatric Surgery

Complications and Failure to Rescue After Inpatient Pediatric Surgery

Automated Frailty Screening At‐Scale for Pre‐Operative Risk Stratification Using the Electronic Frailty Index

Surgical Treatment of Nonmelanoma Skin Cancer in Older Adult Veterans

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