Frailty among older surgical patients and risk of hospital acquired adverse events: The South‐Western Sydney frailty and nurse sensitive indicators study

Abstract

Background While advances in healthcare mean people are living longer, increasing frailty is a potential consequence of this. The relationship between frailty among older surgical patients and hospital acquired adverse events has not been extensively explored. We sought to describe the relationship between increasing frailty among older surgical patients and the risk of hospital acquired adverse events. Methods We included consecutive surgical admissions among patients aged 70 years or more across the SWSLHD between January 2010 and December 2020. This study used routinely collected ICD‐10‐AM data, obtained from the government maintained Admitted Patient Data Collection. The relationships between cumulative frailty deficit items and risk of hospital acquired adverse events were assessed using Poisson regression modelling. This study followed the RECORD/STROBE guidelines. Results During the study period, 44,721 (57% women) older adults were admitted, and 41% (25,306) were planned surgical admissions. The risk of all adverse events increased with increasing number of frailty deficit items, the highest deficit items group (4–12 deficit items) compared with the lowest deficit items group (0 or 1 deficit item): falls adjusted rate ratio (adj RR) = 15.3, (95% confidence interval (CI) 12.1, 19.42); pressure injury adj RR = 21.3 (95% CI 12.53, 36.16); delirium adj RR = 40.9 (95% CI 31.21, 53.55); pneumonia adj RR = 16.5 (95% CI 12.74, 21.27); thromboembolism adj RR = 17.3 (95% CI 4.4, 11.92); and hospital mortality adj RR = 6.2 (95% CI 5.18, 7.37). Conclusion The increase in number of cumulative frailty deficit items among older surgical patients was associated with a higher risk of adverse hospital events. The link offers an opportunity to clinical nursing professionals in the surgical setting, to develop and implement targeted models of care and ensure the best outcomes for frail older adults and their families.

Frailty in the prediction of delirium in the intensive care unit: A secondary analysis of the Deli study

“…39 The use of prediction models has shown promise in predicting several types of delirium, including postoperative and subsyndromal delirium as well as delirium in the ICU. 40 Frailty status has been identified as an important predictor in the surgical setting 41,42 and among trauma patients, 43 however, not in the general intensive care population. An important innovation in the intensive care setting appears to be the use of machine learning and the use of dynamic prediction models.…”

Assessment, management and prevention of chronic wounds in the Australian context: a scoping review

“…• Malnutrition 476,477,478 • Admissions from residential aged care facilities 115 • Body shape 479 • Physical activity/position 480,481 • Multiple comorbidities 115,482 • Increased frailty 483 • Incontinence-associated dermatitis 484 Critically ill /intensive care inpatients • Use of vasoactive agents, extra corporeal membrane oxygenation and mechanical ventilation 114 • Oxygen tubing behind ears, nasogastric tubes 120 • Endotracheal tubes 120,121,485 • Time in a cervical collar and length of ICU stay 110 Operative theatre…”