Preoperative frailty is a risk factor for non-home discharge in patients undergoing surgery for endometrial cancer

Adedayo, Pelumi; Resnick, Kimberly; Singh, Sareena

doi:10.1016/j.jgo.2018.02.005

Cited by 25 publications

(20 citation statements)

References 12 publications

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“…A retrospective cohort study utilized a modified frailty index which used diabetes, impaired functional status, chronic obstructive pulmonary disease, impaired sensorium, transient ischemic attack, and cerebral vascular accident to assess baseline frailty in patients with endometrial cancer undergoing hysterectomy, and its association with discharge to post-acute care. With frailty defined as having two of the eleven indices present, the study showed frailty had an odds ratio of 1.95 (95% CI 1.91-5.01) and disseminated cancer had an odds ratio of 10 (95% CI 2.28-44.1) for discharge to post-acute care 14 . The strong association between the presence of disseminated cancer and discharge to post-acute care may partially explain why our study, in which almost half the patients had disseminated cancer, found the ACS NSQIP calculator tended to overestimate risk of discharge to postacute care and thus decreased predictive ability compared to studies in the general surgery population.…”

Section: Discussionmentioning

confidence: 94%

The American College of Surgeon's surgical risk calculator's ability to predict disposition in older gynecologic oncology patients undergoing laparotomy

Shaker

Rivard

Nahum

et al. 2019

Journal of Geriatric Oncology

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Objectives: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator calculates risk of postoperative complications utilizing clinically apparent preoperative variables. If validated for patients with gynecologic , this can be an effective tool in to use for shared decision-making, especially in the older (70+ years of age) patient population for whom surgical risks and potential loss of independence is increased. The primary objective of this study was to evaluate the ability of the ACS NSQIP surgical risk calculator to predict discharge to a post-acute care among older (age 70+ years) gynecologic oncology patients undergoing laparotomy. The secondary objectives were to assess its ability to predict postoperative complications and death. Methods: This was a retrospective cohort study of gynecologic oncology patients 70+ years of age undergoing laparotomy. Surgical procedures, 21 preoperative variables, postoperative complications, and patient disposition were abstracted from the medical record. Risk scores for seven postoperative complications and discharge to post-acute care were calculated. The association between risk scores and outcomes were assessed using logistic regression and predictive ability was evaluated using the c-statistic and Brier score. Results: 204 surgeries were performed on 200 patients between January 1, 2009 and December 31, 2013. The mean age was 76.3±5.1 years; 87% were independent at baseline. A total of 79 (41%) were discharged to post-acute care. The calculator's ability to predict discharge to post-* Corresponding author at: Mayo Mail Code 395, 420 Delaware St SE, Minneapolis, MN 55417. AUTHOR CONTRIBUTIONS SS contributed to the data acquisition, quality control of data and algorithms, data analysis and interpretation, manuscript preparation, editing, and review. CR contributed to the study concepts and study design, manuscript editing, and manuscript review. RN contributed to the data acquisition, manuscript editing, and manuscript review. RIV contributed to the data analysis and interpretation, statistical analysis, manuscript preparation, editing, and review. DT contributed to the study design and concepts, quality control of data and algorithms, data analysis and interpretation, manuscript preparation, editing, and review.

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Section: Discussionmentioning

confidence: 94%

The American College of Surgeon's surgical risk calculator's ability to predict disposition in older gynecologic oncology patients undergoing laparotomy

Shaker

Rivard

Nahum

et al. 2019

Journal of Geriatric Oncology

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“…In‐hospital mortality was defined from discharge disposition. non‐home–based discharge was defined according to the final disposition at discharge 27 . Length of stay was calculated by subtracting the admission date from the discharge date.…”

Section: Methodsmentioning

confidence: 99%

“…non-home-based discharge was defined according to the final disposition at discharge. 27 Length of stay was calculated by subtracting the admission date from the discharge date. Finally, inflation-adjusted THCs were defined according to NIS methodology.…”

Section: Variables Definitionmentioning

confidence: 99%

Preoperative frailty predicts adverse short‐term postoperative outcomes in patients treated with radical nephroureterectomy

Rosiello

Palumbo

Deuker

et al. 2020

Journal of Surgical Oncology

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Background To investigate the effect of frailty on short‐term postoperative outcomes and total hospital charges (THCs) in patients with non‐metastatic upper urinary tract carcinoma, treated with radical nephroureterectomy (RNU). Methods Within the National Inpatient Sample (NIS) database we identified 11 258 RNU patients (2000‐2015). We used the Johns Hopkins frailty‐indicator to stratify patients according to frailty status. Time trends and multivariable logistic, Poisson and linear regression models were applied. Results Overall, 1801 (16.0%) patients were frail, 4664 (41.4%) were older than 75 years and 1530 (13.6%) had Charlson comorbidity index ≥2. Rates of frail patients increased over time, from 7.3% to 24.9% (P < .001). Frail patients exhibited higher rates (all P < .05) of overall complications (62.6% vs 50.9%), in‐hospital mortality (1.6% vs 1.0%), non‐home–based discharge (22.7% vs 12.1%), longer length of stay (LOS) (6 vs 1 day) and higher THCs ($49 539 vs $39 644). Moreover, frailty independently predicted (all P < .05) overall complications (OR, 1.46), in‐hospital mortality (OR, 1.52), non‐home–based discharge (OR, 1.36), longer LOS (RR, 1.30) and higher THCs (RR, +$11 806). Conclusion Preoperative frailty is important in RNU patients. One of four RNU patients is frail. Moreover, frailty predicts short‐term postoperative complications, as well as longer LOS and higher THCs after RNU.

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“…Major complications also increase patient length of stay, limiting healthcare system resources for additional patients. Furthermore, medically frail patients have significantly higher rates of post-surgical non-home discharge and discharge admissions to care facilities [ 4 ], a finding supported in the gynecologic oncology literature [ 8 14 ]. The cost of these facility stays, as well as the costs involved in discharge planning, compounds the long-term increased healthcare system costs associated with medical frailty [ 15 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…These trends have also been observed in gynecologic oncology patients. Compared to non-frail women, medically frail elderly women experience significantly higher rates of 30-day postoperative complications, higher 90-day mortality, and an increased likelihood of requiring increased levels of care at discharge [ 6 7 8 9 ]. It is imperative to incorporate the impact of frailty and develop tailored management strategies to optimize care for this higher-risk demographic.…”

Section: Introductionmentioning

confidence: 99%

Prehabilitation for medically frail patients undergoing surgery for epithelial ovarian cancer: a cost-effectiveness analysis

et al. 2021

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Objective To assess the potential cost-effectiveness of prehabilitation in medically frail patients undergoing surgery for epithelial ovarian cancer (EOC). Methods We created a cost-effectiveness model evaluating the impact of prehabilitation on a cohort of medically frail women undergoing primary surgical intervention for EOC. Cost was assessed from the healthcare system perspective via (1) inpatient charges from 2018–2019 institutional Diagnostic Related Grouping data for surgeries with and without major complications; (2) nursing facility costs from published market surveys. Major complication and non-home discharge rates were estimated from the literature. Based on published pilot studies, prehabilitation was determined to decrease these rates. Incremental cost-effectiveness ratio for cost per life year saved utilized a willingness-to-pay threshold of $100,000/life year. Modeling was performed with TreeAge software. Results In a cohort of 4,415 women, prehabilitation would cost $371.1 Million (M) versus $404.9 M for usual care, a cost saving of $33.8 M/year. Cost of care per patient with prehabilitation was $84,053; usual care was $91,713. When analyzed for cost-effectiveness, usual care was dominated by prehabilitation, indicating prehabilitation was associated with both increased effectiveness and decreased cost compared with usual care. Sensitivity analysis showed prehabilitation was more cost effective up to a cost of intervention of $9,418/patient. Conclusion Prehabilitation appears to be a cost-saving method to decrease healthcare system costs via two improved outcomes: lower complication rates and decreased care facility requirements. It represents a novel strategy to optimize healthcare efficiency. Prospective studies should be performed to better characterize these interventions in medically frail patients with EOC.

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Preoperative frailty is a risk factor for non-home discharge in patients undergoing surgery for endometrial cancer

Cited by 25 publications

References 12 publications

The American College of Surgeon's surgical risk calculator's ability to predict disposition in older gynecologic oncology patients undergoing laparotomy

The American College of Surgeon's surgical risk calculator's ability to predict disposition in older gynecologic oncology patients undergoing laparotomy

Preoperative frailty predicts adverse short‐term postoperative outcomes in patients treated with radical nephroureterectomy

Prehabilitation for medically frail patients undergoing surgery for epithelial ovarian cancer: a cost-effectiveness analysis

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