MedicalResearch.com Interview with:
Daniel E. Hall, MD, MDiv, MHSc, FACS
Associate Professor of Surgery
University of Pittsburgh Staff Surgeon
VA Pittsburgh Healthcare System Core Investigator
VA Center for Health Equity Research and Promotion.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A growing body of research demonstrates that frailty is a more powerful predictor of postoperative outcomes than risk-prediction models based on age or comorbidity alone. However, it has not been clear if surgeons could intervene on frailty to improve outcomes.
This study reports what we believe to be the first ever demonstration that it is not only feasible to screen an entire health system for frailty, but that it is possible to act on that information to improve outcomes. Every patient evaluated for elective surgery was screened for frailty with a brief tool that takes 1-2 minutes to complete. Those identified as potentially frail and thus at greater risk for poor surgical outcomes received an ad-hoc administrative review aimed at optimizing perioperative care. After implementing the frailty screening initiative, we observed a 3-fold increase in long-term survival at 6 and 12 months—even after controlling for age, frailty, and predicted mortality.
MedicalResearch.com: What should readers take away from your report?
Response: The precise mechanisms of the improvement is not clear and likely multifactorial given the complex behavioral modification induced by the intervention. However, these data provide preliminary proof of concept that frailty can be feasibly assessed preoperatively across entire health systems, and knowledge of the diagnosis can inform care in ways that improve outcomes.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: This study involved only a single hospital in Omaha, Nebraska. We need to see if it translates to other settings. In fact, other other VA and private hospitals are currently implementing similar strategies that will hopefully replicate the findings and improve the quality of perioperative care for some of the highest risk patients we serve.
MedicalResearch.com: Is there anything else you would like to add?
Response: As the US and VA health care user population ages, the prevalence of frailty will increase, and an increasing number of frail patients will require surgical care. This is another example of how VA’s integrated research, clinical care and electronic medical records are leading the country to identify and act on unrecognized opportunities for ongoing quality improvement. The strategies identified here will not only help the VA fulfill its mandate to provide high-value medical care to those who have born the burden of battle, but they may also help private sector hospitals and physicians improve the care of the frail patients they serve.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Hall DE, Arya S, Schmid KK, Carlson MA, Lavedan P, Bailey TL, Purviance G, Bockman T, Lynch TG, Johanning JM. Association of a Frailty Screening Initiative With Postoperative Survival at 30, 180, and 365 Days. JAMA Surg. Published online November 30, 2016. doi:10.1001/jamas
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