Frailty and risk of postoperative complications
Background: FTR is a quality measure defined as death after a serious, potentially preventable complication. Frailty incorporates different domains including physical performance, gait, mobility, nutritional status, mental health, and cognition. Although there are some studies linking frailty and FTR and postoperative morbidity, the degree and association with low-risk procedures is unclear.
Dr. Fabrizio Canepa
Study design: Retrospective cohort study.
Setting: More than 600 hospitals participating in the American College of Surgeons’ National Surgical Quality Improvement Program database during 2005-2012.
Synopsis: The cohort included 984,550 adult patients who underwent inpatient procedure for general, vascular, thoracic, cardiac, and orthopedic operations. The Risk Analysis Index (RAI) score was used to calculate frailty. The rate of major complications increased as the RAI score was higher for both low-risk and high-risk surgery. For RAI scores less than 10, the rate was 7.4%; for RAI scores 11-20, the rate was 19.8%; for RAI scores 21-30, the rate was 41.1%; and for RAI scores above 40, the rate was 53.6%. Stratifying by the number of complications, significant increases in FTR were observed across the RAI categories for both low-risk and high-risk procedures.
Frailty assessment should be considered a part of the routine perioperative evaluation and should stimulate preoperative interventions aimed at reducing risk for postoperative complications.
Bottom line: This large retrospective study found an association between increasing frailty and both the number of complications and FTR for both low-risk and high-risk surgical procedures.
Citation: Shah R et al. Association of frailty with failure to rescue after low-risk and high-risk inpatient surgery. JAMA Surg. 2018 Mar 21;153(5):e180214.
Dr. Canepa is a hospitalist in the division of hospital medicine at the University of Kentucky, Lexington.
