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Frailty screening after surgery may decrease complications, readmissions
Screening for frailty may decrease unplanned readmissions and complications after elective outpatient surgery, according to a study published in JAMA Network Open.
“Frailty is a syndrome of increased vulnerability to a stressor, which can disrupt physiological homeostasis and degrade health status,” Kara A. Rothenberg, MD, of the Stanford-Surgery Policy Improvement Research and Education Center and the department of surgery at Stanford University School of Medicine, and colleagues wrote. “Frail patients have an increased risk of postoperative complications in many clinical contexts. More recently, however, research has focused on the association of frailty with quality metrics, such as failure to rescue (ie, death after a potentially preventable complication) and hospital readmissions, both of which are more likely to occur in frail individuals.”
Researchers retroactively identified patients who had elective outpatient surgery using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant files from 2012 and 2013. Information from NSQIP was used to determine if the patient had inpatient or outpatient status, whether the surgery was elective and the length of stay (LOS). Participants were divided into two cohorts based on whether they were hospitalized for less than 1 (LOS = 0) or more than 1 (LOS 1) day. Frailty was measured with a Risk Analysis Index determined by variables in the NSQIP.
The primary outcome of the study was unplanned readmission within 30 days of surgery.
A total of 417,840 patients were included in the study, with unplanned readmission occurring in 2.3% of patients (LOS = 0, 2%; LOS 1, 3.4%). Researchers found that frail patients in the study (mean age 64.9 years) had a higher chance of unplanned readmission than nonfrail patients (mean age, 35 years) in the LOS = 0 cohort (8.3% vs 1.9%; P < .001) and LOS 1 (8.5% vs 3.2%; P < .001). Complications were more common in frail patients in both LOS cohorts (LOS = 0, 6.9% vs 2.5%; LOS 1, 9.8% vs 4.6%; P < .001) compared with nonfrail patients.
A multivariant analysis found that frailty doubled a patient’s risk of unplanned readmission (LOS = 0: adjusted RR = 2.1; 95% CI, 2.0-2.3; LOS 1: aRR = 1.8; 95% CI, 1.6-2.1). Complications occurred in only 3.1% of the cohort, but patients with frailty were associated with an increased risk for complications (unadjusted RR = 2.6; 95% CI, 2.4-2.8).
“Preoperative identification of [frail] patients may lead to better outcomes and reduced readmissions by improved patient setting and/or improved perioperative care pathways including improved rehabilitation before surgery, frailty-specific anesthetic pathways during surgery, and postoperative follow-up aimed at early identification and outpatient management of complications,” Rothenberg and colleagues wrote. – by Erin Michael
Disclosures: Rothenberg reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.