Risk assessment for postoperative outcomes in a mixed hospitalized gynecological population by the Dutch safety management system (Veiligheidsmanagementsysteem, VMS) screening tool ‘frail elderly’

Abstract

Purpose Frailty is associated with a higher risk for negative postoperative outcomes. This study aimed to determine the association between the screening tool of the Dutch safety management system, Veiligheidsmanagementsysteem (VMS) ‘frail elderly’ and postoperative complications in a gynecological population. Methods This cohort study included women aged 70 years or older, who were scheduled for any kind of gynecological surgery. VMS screening data (including risk for delirium, falling, malnutrition, and functional impairment) were extracted from the electronic patient records. VMS score could range between 0 and 4 patients with a VMS score of one or more were considered frail. Data on possible confounding factors and complications within 30 days after surgery, classified with the Clavien–Dindo classification, were collected. Regression analysis was performed. Results 157 women were included with a median age of 74 years (inter quartile range 71–79). Most patients underwent prolapse surgery (52%) or hysterectomy (31%). Forty-one patients (26%) experienced any postoperative complication. Sixty-two patients (39%) were considered frail preoperatively by the VMS screening tool. Frailty measured with the VMS screening tool was not independently associated with postoperative complications in multivariable analysis (Odds ratio 1.18; 95% CI 0.49–2.82). However, a recent fall in the last 6 months (n = 208) was associated with postoperative complications (Odds ratio 3.90; 95% CI 1.57–9.66). Conclusion An independent association between frailty, determined by the VMS screening tool ‘Frail elderly’, and postoperative complications in gynecological surgery patients could not be confirmed. A recent fall in the last 6 months seems associated with postoperative complications.

Association of Vulnerability Screening on Hospital Admission with Discharge to Rehabilitation-Oriented Care after Acute Hospital Stay

“… 20 , 21 , 36 ) No association was found between DSMS vulnerability and mortality, complications, or readmission in geriatric, cardiac, or gynecological patients. 19 , 37 - 39 ) However, in patients with hip fractures, the DSMS vulnerability score was positively associated with mortality and a complicated rehabilitation trajectory. 40 , 41 ) Moreover, low to moderate prognostic accuracy has been reported for functional decline, morbidity, hospital readmission, institutionalization, and long-term survival.…”

Analysis of the Reliability and Validity of the Johns Hopkins Fall Risk Assessment Scale in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

“…Validity is mainly used to evaluate the accuracy and validity of scales, and common evaluation indicators include calibration association, structure, and content validities [19,20]. CVI ranges from 0 to 1, and a high value is indicative of the good representativeness and suitability of the items of the scale [21].…”