MedicalResearch.com Interview with:
Rachel Khadaroo, MD, PhD, FRCSC
Associate Professor of Surgery
Department of Surgery & Division of Critical Care Medicine
University of Alberta
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The elderly are the fastest growing population in North America. There are very few studies that have examined the impact of frailty and age on outcomes following abdominal surgery. Readmissions are expensive have been considered an important quality indicator for surgical care. This study examined 308 patients 65 years and older who were admitted for emergency abdominal surgery in two hospitals in Alberta and followed them for 6 months for readmission or death. Patients were classified into 3 categories: Well, pre-frail (no apparent disability), and frail.
MedicalResearch.com: What should readers take away from your report?
Response: Readers should know by 6 months following surgery one third of all patients were readmitted to hospital or died. In the study 75% of the patients were either pre-frail or frail. Compared to well patients the pre-frail and frail patients were more than four times more likely to be readmitted or die within 30 days after discharge from hospital. Importantly, although this may be suspected for frail patients this was true for the pre-frail patients who had no apparent disability and lived independently.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Currently assessing the degree of frailty is not routinely practiced prior to surgery in most centres. We recommend to use validated tools to identify frailty to assist in determining who will be at increased risk following surgery. More studies are needed to assess the impact and feasibility of interventions on this vulnerable population. We are trying to address this at the University of Alberta Hospital where we are now researching a new model of care for surgical patients called Elder-friendly Approaches to the Surgical Environment (EASE) https://dx.doi.org/10.1186%2Fs12913-015-1001-2. This model includes a multidisciplinary team including a geriatrician, early mobilization, delirium prevention, and early involvement of patients’ and their supports to plan for a safe return to home.
I have no disclosures.
Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study
Yibo Li, Jenelle L. Pederson, Thomas A. Churchill, Adrian S. Wagg, Jayna M. Holroyd-Leduc, Kannayiram Alagiakrishnan, Raj S. Padwal and Rachel G. Khadaroo
CMAJ February 20, 2018 190 (7) E184-E190; DOI: https://doi.org/10.1503/cmaj.161403
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