MedicalResearch.com Interview with:
Kara Anne Rothenberg.MD
Postdoctoral Research Fellow, Vascular Surgery
Shipra Arya, MD SM FACS
Associate Professor of Surgery
Stanford University School of Medicine
MedicalResearch.com: What is the background for this study?
Response: There is a growing body of literature showing that frailty, a syndrome where patients have increased vulnerability to a stressor (such as surgery), is associated with increased postoperative complications, failure to rescue, and hospital readmissions.
The Risk Analysis Index (RAI), is an easy to use frailty measurement tool that better predicts postoperative mortality than age or comorbidities alone. As the rates of outpatient surgeries rise nationwide, we noted that most of the surgical frailty studies focus only on inpatient surgeries. Elective, outpatient surgery is generally considered low risk for complications and unplanned readmissions, however we hypothesized that for frail patients, it might not be.
MedicalResearch.com: What are the main findings?
Response: From 2012-2013, we included 417,840 elective, outpatient surgeries from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database. Of these, 2.5-3.1% patients were determined to be frail, as calculated by the RAI. Frail patients had a higher risk of complications (6.9-9.8% versus 2.5-4.6%) and unplanned readmission (8.3-8.5% versus 1.9-3.2%) compared to non-frail patients.
In multivariate analysis, frailty doubled the risk of unplanned readmission, which was only partially mediated by complications.
MedicalResearch.com: What should readers take away from your report?
Response: While elective, outpatient surgery is safe, with few unplanned readmissions, the risk of readmission is much higher for frail patients, both independently and partially mediated through increased complications.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We would recommend that routine frailty screening be performed prior to all types of surgery, including those that would normally be considered low risk enough to be performed on an outpatient basis. The benefit of using the RAI is that it can be performed in under one minute during a preoperative clinic visit, and can be patient-reported. By identifying frail patients preoperatively, we as surgeons can be better prepared to discuss surgical risk for each patient, and engage in shared decision-making.
This study was supported by the NIH/NIA (5R03AG050930).
Rothenberg KA, Stern JR, George EL, et al. Association of Frailty and Postoperative Complications With Unplanned Readmissions After Elective Outpatient Surgery. JAMA Netw Open. 2019;2(5):e194330. doi:10.1001/jamanetworkopen.2019.4330
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