Frailty and Surgery

iStock-489309852People who are frail don't do as well during and after surgery as those who aren't. Duh. Now a study Rick and I discuss on PodMed this week and published in JAMA Surgery attempted to assess frailty preoperatively and develop a plan for afterward, with results that are impressive indeed.

Beginning in October 2007 to July 1, 2014, all patients who came to a single Veteran's Administration medical center for major, elective non-cardiac surgery were assessed preoperatively using a frailty index, and those who were identified as frail comprehensively evaluated by a multidisciplinary team, who created a plan for their care. Here are the results directly from the paper:

Results  From October 1, 2007, to July 1, 2014, a total of 9153 patients underwent surgery (mean [SD] age, 60.3 [13.5] years; female, 653 [7.1%]; and white, 7096 [79.8%]). Overall 30-day mortality decreased from 1.6% (84 of 5275 patients) to 0.7% (26 of 3878 patients, P < .001) after FSI implementation. Improvement was greatest among frail patients (12.2% [24 of 197 patients] to 3.8% [16 of 424 patients], P < .001), although mortality rates also decreased among the robust patients (1.2% [60 of 5078 patients] to 0.3% [10 of 3454 patients], P < .001). The magnitude of improvement among frail patients increased at 180 (23.9% [47 of 197 patients] to 7.7% [30 of 389 patients], P < .001) and 365 days (34.5% [68 of 197 patients] to 11.7% [36 of 309 patients], P < .001). Multivariable models revealed improved survival after FSI implementation, controlling for age, frailty, and predicted mortality (adjusted odds ratio for 180-day survival, 2.87; 95% CI, 1.98-4.16).

Rick and I agree that this is impressive indeed, and I am especially impressed by the statement I bolded above, that even among those who weren't deemed to be at risk such an assessment substantially improved outcomes. And among all comers, the results were durable for 180 days.  Sounds like a clear imperative to implement such a strategy globally.

Other topics this week include Accuracy of a Deep Learning Algorithm for Detection of Diabetic RetinopathySwimming, aerobics, and racquet sports are linked to lowest risk of cardiovascular death from the BMJ, and Pronounced increase in risk of acute ST-segment elevation myocardial infarction in younger smokers, from Heart.  Until next week, y'all live well.

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