Use of the Modified Frailty Index in the American College of Surgeons National Surgical Improvement Program Database

JAMA Surgery ◽  
2017 ◽  
Vol 152 (2) ◽  
pp. 205 ◽  
Author(s):  
Faiz Gani ◽  
Joseph K. Canner ◽  
Timothy M. Pawlik
Keyword(s):  
Frailty Index ◽  
Improvement Program ◽  
American College Of Surgeons ◽  
Modified Frailty Index

scholarly journals The Impact of Frailty on Morbidity and Mortality following Open Emergent Colectomies

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Dominick V. Congiusta ◽  
Prashanth Palvannan ◽  
Aziz M. Merchant
Keyword(s):  
Care Setting ◽  
Frailty Index ◽  
Acute Care Setting ◽  
Improvement Program ◽  
Mortality And Morbidity ◽  
National Quality ◽  
American College Of Surgeons ◽  
Modified Frailty Index ◽  
The Impact ◽  
The Relationship

Background. Elderly and frail patients undergo open emergency colectomies and are at greater risk for complications. The relationship between frailty and open emergent colectomies is yet unexplored.Objective. The purpose of this study was to evaluate the relationship between frailty and outcomes after open emergent colorectal surgery.Design. Using the American College of Surgeons National Quality Improvement Program database, a validated modified frailty index was used, along with logistic regression, to assess the relationship between frailty and outcomes.Main Outcome Measures. Outcomes included mortality (primary), Clavien-Dindo Complication Grade >3, reintubation, ventilator >48 hours, and reoperation (secondary).Results. The rates for 30-day mortality, Clavien-Dindo Grade >3, reintubation, ventilator > 48 hours, and reoperation in our cohort were 16.6%, 36.9%, 8.6%, 23.9%, and 15.0%, respectively. There was a statistically significant increase in prevalence of all outcomes with increasing frailty.Limitations. A causal relationship between frailty and complications cannot be established in a retrospective analysis. Also, extrapolation of our data to reflect outcomes beyond 30 days must be done with caution.Conclusions. Frailty is a statistically significant predictor of mortality and morbidity after open emergent colectomies and can be used in an acute care setting.

scholarly journals P.221 Frailty is an Important Predictor of 30-day Morbidity in Patients Treated for Lumbar Spondylolisthesis Using a Posterior Surgical Approach

2021 ◽  
Vol 48 (s3) ◽  
pp. S83-S84
Author(s):  
V Chan ◽  
C Witiw ◽  
J Wilson ◽  
MG Fehlings
Keyword(s):  
Frailty Index ◽  
Major Complication ◽  
Unplanned Readmission ◽  
Improvement Program ◽  
Posterior Surgery ◽  
Increased Risk ◽  
Degenerative Lumbar Spondylolisthesis ◽  
American College Of Surgeons ◽  
Modified Frailty Index ◽  
Lumbar Spondylolisthesis

Background: A non-operative approach has been favoured for elderly patients with lumbar spondylolisthesis due to a perceived higher risk with surgery. However, most studies have used an arbitrary age cut-off to define “elderly.” We hypothesized that frailty is an independent predictor of morbidity after surgery for lumbar spondylolisthesis. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for years 2010 to 2018 was used. Patients who received posterior lumbar spine decompression with or without posterior fusion instrumented fusion for degenerative lumbar spondylolisthesis were included. The primary outcome was major complication. Secondary outcomes were readmission, reoperation, and discharge to location other than home. Logistic regression analysis was done to investigate the association between outcomes and frailty. Results: There were 15 658 patients in this study. The mean age was 62.5 years (SD 12.2). Frailty, as measured by the Modified Frailty Index-5 was significantly associated with increased risk of major complication, unplanned readmission, reoperation, and non-home discharge. Increasing frailty was associated with increasing risk of morbidity. Conclusions: Frailty is independently associated with higher risk of morbidity after posterior surgery in patients with lumbar spondylolisthesis. These data are of significance to clinicians in planning treatment for these patients.

Adapting the 5-factor modified frailty index for prediction of postprocedural outcome in patients with unruptured aneurysms

2021 ◽  
pp. 1-8
Author(s):  
James Feghali ◽  
Abhishek Gami ◽  
Sarah Rapaport ◽  
Jaimin Patel ◽  
Adham M. Khalafallah ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Frailty Index ◽  
Multivariable Analysis ◽  
Unruptured Aneurysm ◽  
Improvement Program ◽  
Unruptured Aneurysms ◽  
Major Complications ◽  
C Statistic ◽  
Physical Status Classification ◽  
Modified Frailty Index

OBJECTIVE The 5-factor modified frailty index (mFI-5) is a practical tool that can be used to estimate frailty by measuring five accessible factors: functional status, history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. The authors aimed to validate the utility of mFI-5 for predicting endovascular and microsurgical treatment outcomes in patients with unruptured aneurysms. METHODS A prospectively maintained database of consecutive patients with unruptured aneurysm who were treated with clip placement or endovascular therapy was used. Because patient age is an important predictor of treatment outcomes in patients with unruptured aneurysm, mFI-5 was supplemented with age to create the age-supplemented mFI-5 (AmFI-5). Associations of scores on these indices with major complications (symptomatic ischemic or hemorrhagic stroke, pulmonary embolism, pneumonia, or surgical site infection requiring reoperation) were evaluated. Validation was carried out with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2006–2017). RESULTS The institutional database included 275 patients (88 underwent clip placement, and 187 underwent endovascular treatment). Multivariable analysis of the surgical cohort showed that major complication was significantly associated with mFI-5 (OR 2.0, p = 0.046) and AmFI-5 (OR 1.9, p = 0.028) scores. Significant predictive accuracy for major complications was provided by mFI-5 (c-statistic = 0.709, p = 0.011) and AmFI-5 (c-statistic = 0.720, p = 0.008). The American Society of Anesthesiologists Physical Status Classification System (ASA) provided poor discrimination (area under the curve = 0.541, p = 0.618) that was significantly less than that of mFI-5 (p = 0.023) and AmFI-5 (p = 0.014). Optimal relative fit was achieved with AmFI-5, which had the lowest Akaike information criterion value. Similar results were obtained after equivalent analysis of the endovascular cohort, with additional significant associations between index scores and length of stay (β = 0.6 and p = 0.009 for mFI-5; β = 0.5 and p = 0.003 for AmFI-5). In 1047 patients who underwent clip placement and were included in the NSQIP database, mFI-5 (p = 0.001) and AmFI-5 (p < 0.001) scores were significantly associated with severe postoperative adverse events and provided greater discrimination (c-statistic = 0.600 and p < 0.001 for mFI-5; c-statistic = 0.610 and p < 0.001 for AmFI-5) than ASA score (c-statistic = 0.580 and p = 0.003). CONCLUSIONS mFI-5 and AmFI-5 represent potential predictors of procedure-related complications in unruptured aneurysm patients. After further validation, integration of these tools into clinical workflows may optimize patients for intervention.

New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data

2018 ◽  
Vol 226 (2) ◽  
pp. 173-181.e8 ◽  
Author(s):  
Sneha Subramaniam ◽  
Jeffrey J. Aalberg ◽  
Rainier P. Soriano ◽  
Celia M. Divino
Keyword(s):  
Frailty Index ◽  
American College Of Surgeons ◽  
Modified Frailty Index

The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury

2020 ◽  
Vol 86 (11) ◽  
pp. 1596-1601
Author(s):  
Brett M. Tracy ◽  
Margo N. Carlin ◽  
James W. Tyson ◽  
Mara L. Schenker ◽  
Rondi B. Gelbard
Keyword(s):  
Traumatic Brain Injury ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Brain Injury ◽  
Frailty Index ◽  
Kidney Injury ◽  
Care Hospital ◽  
Improvement Program ◽  
Multivariable Logistic Regression ◽  
Modified Frailty Index

Background Frailty has been studied extensively in trauma, but there is minimal research detailing its impact on traumatic brain injury (TBI). We hypothesized that the 11-item modified frailty index (mFI-11) would predict complications and discharge outcomes in patients with TBI. Methods A retrospective review of our trauma quality improvement program (TQIP) registry was conducted for all patients with TBI. The mFI-11 score was calculated for each patient. Multivariable logistic regression was used to assess the relationship between mFI-11 and cardiovascular, infectious, pulmonary, renal, thromboembolic, and unplanned complications (ie, unplanned intensive care unit [ICU] admission, intubation, or return to the operating room). Results There were 2352 patients with TBI of whom 61.6% (n = 1450) were not frail, 19.3% (n = 454) were mildly frail, and 19.1% (n = 448) were moderately to severely frail. Higher frailty scores were associated with increasing age ( P < .0001) and decreasing injury severity score [ISS] ( P = 0.001). Higher frailty scores also correlated with increasing rates of a skilled nursing facility/long-term acute care hospital/rehabilitation discharge ( P = .0002). On multivariable logistic regression adjusting for age, Glasgow Coma Scale (GCS) score, ISS, mechanism, and sex, moderate to severe frailty increased the odds of acute kidney injury (odds ratio [OR] 2.06, 95% CI 1.07-3.99, P = .03) and any unplanned event (OR 1.6, 95% CI 1.1-2.3, P = .01). Conclusion Frailty measured by the mFI-11 is associated with greater rates of discharge to unfavorable locations and increased odds of acute kidney injury and unplanned events among patients with TBI. These findings suggest that frail patients with TBIs require greater vigilance to avoid such unanticipated outcomes.

Frailty: A major consideration for short- and long-term outcomes in resected pancreatic cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 418-418
Author(s):  
Ioannis Konstantinidis ◽  
Aaron G Lewis ◽  
Federrico Tozzi ◽  
Philip HG Ituarte ◽  
Susanne Warner ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Frailty Index ◽  
Postoperative Mortality ◽  
Postoperative Outcome ◽  
Postoperative Outcomes ◽  
Improvement Program ◽  
California Cancer Registry ◽  
Modified Frailty Index ◽  
Comorbidity Index ◽  
Short And Long Term

418 Background: Frailty has been associated with adverse postoperative outcomes. However, little is known about its correlation with survival in resected pancreatic cancer. This study examined the correlation of frailty with postoperative outcomes and survival after pancreatectomy for cancer. Methods: Data from National Surgical Quality Improvement Program (NSQIP) patients (n = 7400) who underwent pancreatectomy between 2011 to 2013. A modified frailty index (mFI) validated for use in NSQIP was used to examine correlations between frailty and postoperative outcomes. California Cancer Registry (CCR) data for patients (n = 4959) who underwent pancreatectomy for cancer between 2000 to 2012 was used to assess the association between the Charlson Comorbidity Index (CCI), as a surrogate for frailty, and overall survival. Results: The distribution of NSQIP patients according to the mFI was 0, 1, 2, 3, 4 in 2797 (37.8%), 3422 (46.2), 1074 (14.5), 104 (1.4) and 3 (0.04) respectively. The patients were divided to non frail (mFI = 0), mildly frail (mFI = 1-2), or severely frail (mFI3 ≥ 3). Overall, 8.7% of patients experienced a grade 4 Clavien complication and 3.1% experienced postoperative mortality. Worsening frailty correlated with an increase in grade 4 Clavien complications (non-frail: 6.3% vs. mildly frail: 9.7% vs. severely frail: 26.2%; p < 0.001) and mortality (1.9% vs. 3.8% vs. 4.7% respectively; p < 0.001). The majority of CCR patients had similarly few comorbidities: CCI: 0, 1, ≥ 2 in 3869 (77.8%), 861 (17.31%) and 243 (4.89%) respectively. Median survival decreased as CCI increased (for CCI 0, 1 and ≥ 2 was 23 vs. 19 vs. 15 months respectively; p < 0.001). Conclusions: Frailty is a powerful correlate of postoperative outcome and survival for resected pancreatic cancer patients and is an important consideration in planning for surgical intervention.

scholarly journals Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery

2016 ◽  
Vol 25 (4) ◽  
pp. 537-541 ◽  
Author(s):  
Rushna Ali ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
Heath J. Antoine ◽  
Ilan Rubinfeld
Keyword(s):  
Risk Stratification ◽  
Spine Surgery ◽  
Postoperative Morbidity ◽  
Frailty Index ◽  
Surgical Site Infections ◽  
Perioperative Risk ◽  
Morbidity And Mortality ◽  
Improvement Program ◽  
Gastrointestinal Problems ◽  
Modified Frailty Index

OBJECTIVE Limited tools exist to stratify perioperative risk in patients undergoing spinal procedures. The modified frailty index (mFI) based on the Canadian Study of Health and Aging Frailty Index (CSHA-FI), constructed from standard demographic variables, has been applied to various other surgical populations for risk stratification. The authors hypothesized that it would be predictive of postoperative morbidity and mortality in patients undergoing spine surgery. METHODS The 2006–2010 National Surgical Quality Improvement Program (NSQIP) data set was accessed for patients undergoing spine surgeries based on Current Procedural Terminology (CPT) codes. Sixteen preoperative clinical NSQIP variables were matched to 11 CSHA-FI variables (changes in daily activities, gastrointestinal problems, respiratory problems, clouding or delirium, hypertension, coronary artery and peripheral vascular disease, congestive heart failure, and so on). The outcomes assessed were 30-day occurrences of adverse events. These were then summarized in groups: any infection, wound-related complication, Clavien IV complications (life-threatening, requiring ICU admission), and mortality. RESULTS A total of 18,294 patients were identified. In 8.1% of patients with an mFI of 0 there was at least one morbid complication, compared with 24.3% of patients with an mFI of ≥ 0.27 (p < 0.001). An mFI of 0 was associated with a mortality rate of 0.1%, compared with 2.3% for an mFI of ≥ 0.27 (p < 0.001). Patients with an mFI of 0 had a 1.7% rate of surgical site infections and a 0.8% rate of Clavien IV complications, whereas patients with an mFI of ≥ 0.27 had rates of 4.1% and 7.1% for surgical site infections and Clavien IV complications, respectively (p < 0.001 for both). Multivariate analysis showed that the preoperative mFI and American Society of Anesthesiologists classification of ≥ III had a significantly increased risk of leading to Clavien IV complications and death. CONCLUSIONS A higher mFI was associated with a higher risk of postoperative morbidity and mortality, providing an additional tool to improve perioperative risk stratification.

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