Elsevier

Surgery

Volume 160, Issue 2, August 2016, Pages 272-280
Surgery

Presented at the Academic Surgical Congress 2016
Impact of frailty on surgical outcomes: The right patient for the right procedure

Presented at the 11th Annual Academic Surgical Congress in Jacksonville, FL, February 2–4, 2016.
https://doi.org/10.1016/j.surg.2016.04.030Get rights and content

Background

Measuring frailty may improve patient selection for high-risk procedures.

Methods

Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent elective high-risk operative procedures, and a frailty index was used to classify the patients.

Results

Our study analyzed 232,352 patients with a mean age of 65 years; the majority of patients were males (54%) and white (78%). The most common procedure was colectomy (41%), followed by lower extremity bypass (25%), gastrectomy (8%), endovascular abdominal aneurism repair (7%), pancreatectomy (7%), cardiac operation (6%), nephrectomy (3%), and pulmonary resection (2%). A majority of the patients were classified as mildly frail (34%), followed by nonfrail (29%), moderately frail (21%), and severely frail (15%). On univariate analysis, age, race, procedure, sex, and frailty scores were associated with complications, prolonged duration of stay, and 30-day mortality (P < .0001). On multivariate analysis, frailty was associated with complications, prolonged duration of stay, and 30-day mortality. Increasing frailty disproportionately impacted mortality; colectomy showed the greatest mortality in severely frail patients (9.36%), followed by esophagectomy (8.2%), pulmonary resection (6.4%), pancreatectomy (5.8%), cardiac procedures (4.4%), gastrectomy (4.3%), nephrectomy (3.32%), endovascular abdominal aneurism repair (2.49%), and lower extremity bypass (2.41%; P = .0001). A similar association between duration of stay and morbidity with frailty was noted.

Conclusion

Frailty has a significant impact on postoperative outcomes that varies with type of procedure.

Section snippets

Data source

In this study, we used the data from ACS-NSQIP Participant Use Files from 2005 to 2012. This is a nationwide dataset containing data entered by trained clinical reviewers. It includes preoperative risk factors, laboratory values, intraoperative data, and the 30-day postoperative morbidity and mortality data. The ACS-NSQIP administration periodically audits the data to ensure reliability. The American College of Surgeons and the hospitals participating in the ACS-NSQIP are the sources of data

Demographics

A total of 232,352 patients who underwent colectomy, pulmonary resection, pancreatectomy, cardiac operation, gastrectomy, nephrectomy, E-AAA, and LEB were identified (Table II). The mean age was 63.9 years (range 16–89) and the median age was 65 years (95% confidence interval [CI], 63.67–63.56). A slight majority were male (54%) and white (78%). Colectomy was the most commonly performed operative procedure followed by LEB, gastrectomy, E-AAA, pancreatectomy, cardiac operation, nephrectomy, and

Discussion

Shifting demographics result in frail patients encountering the operative theater with an increasing frequency. To affect the outcomes in this at-risk population, a clinically useful frailty index tool and an understanding of its implications is imperative. In this study, we identified frail patients using a simple retrospective 11-point index. Frail patients undergoing commonly performed high-risk procedures were found to be more likely to die. The magnitude of impact of frailty varied by

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