Presented at the Academic Surgical Congress 2016Impact of frailty on surgical outcomes: The right patient for the right 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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2021, Gastrointestinal EndoscopyCitation Excerpt :Our results highlight this overall trend, with 44.4% of our study population (representing over 700,000 hospitalized patients from 2016 to 2017) meeting the criteria for frailty. Furthermore, frailty is recognized as a robust predictive measure of outcomes and mortality in a variety of clinical scenarios, for example, after percutaneous coronary intervention, colectomy, pancreatoduodenectomy, cardiac arrest, and spinal surgery.12-15,23-25 However, no studies to date have examined the impact of frailty on clinical endpoints in patients undergoing endoscopy for GIB.
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2021, Surgical OncologyCitation Excerpt :The FI was developed by the Canadian Study of Health and Aging (CSHA), a 70-item scale based on the theory of “accumulating defects”, which correlate with survival. Based on this, Velanovich [14] created a simplified 11-point modified frailty index (mFI) utilizing variables from the National Surgical Quality Improvement Program (NSQIP), which correlated with morbidity and mortality more strongly than age alone, across multiple surgical specialities [15–20]. From a theoretical perspective, frail patients should be the best candidates for minimally invasive surgery (MIS) to reduce surgical stress and complications.