The Addenbrookes Vascular Frailty Score Predicts Adverse Outcomes in Vascular Surgery Patients

Objective: To analyze errors in primary treatment of vascular injuries and delayed presentations of missed vascular injuries as a surrogate indicator of need for improved vascular surgical training of upcoming general surgeons. Materials and methods: This retrospective observational study was carried out at vascular surgery department of two tertiary care hospitals of Armed Forces from Jan 2012 to June 2017. Hospital records of all patients with vascular trauma were analyzed for presence of pitfalls in primary treatment and delayed presentation of missed vascular injuries which resulted in redo surgeries or adverse outcomes. Results: Out of 256 patients with vascular injury sequel 41 had either a problem in primary treatment or presented with delayed complications of missed injuries. The omissions can be divided into: missed injuries (24/41), technical errors in initial repair (12/24), reperfusion of mangled Extremity (3/41) and non availability of a surgeon capable of undertaking vascular repair. The commonest operative fault was failure to debride the vessel adequately and vascular repair under tension. The commonest primary assessment problem was failure to timely appreciate hard signs of vascular injury. Conclusion: With better training and emphasizing the need of thorough clinical examination outcome of vascular trauma can be improved.

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Obesity -Related Frailty: A New Bariatric Frailty Score Can Be Used to Predict Postoperative Adverse Outcomes, Analysis Using The MBSAQIP-2015-2016 Database

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2018.09.044 ◽

2018 ◽

Vol 14 (11) ◽

pp. S24

Author(s):

Raul Sebastian ◽

Andrew Sparks ◽

Gina Adrales ◽

Alisa Coker ◽

Thomas H Magnuson ◽

...

Keyword(s):

Adverse Outcomes ◽

Outcomes Analysis ◽

Frailty Score

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973 The Effect of Implementing A Proactive Care of Older People Undergoing Surgery (‘POPS’) Team on Length of Stay in Older Surgical Patients

British Journal of Surgery ◽

10.1093/bjs/znab134.517 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

J M Bayram ◽

D Rangar ◽

J Dikiciyan ◽

I Smith

Keyword(s):

Length Of Stay ◽

Older People ◽

Vascular Surgery ◽

Patient Outcomes ◽

Nurse Practitioner ◽

Surgical Patients ◽

Medical Complications ◽

Hospital Data ◽

Proactive Care ◽

Frailty Score

Abstract Introduction POPS is a well-established service which supports care of older surgical patients across multiple UK hospitals. POPS teams have been shown to reduce peri-operative medical complications, reduce length of stay (LOS) and improve multiple other patient outcomes. Method A POPS team consisting of two consultants, one foundation doctor and one nurse practitioner was implemented to provide dedicated care to older surgical patients on the general and vascular surgery wards of a large urban teaching hospital. Data were collected over 8 weeks from June 2020 - July 2020 following implementation of the POPS team and compared to pre-POPS data from March 2018 - March 2019. All inpatients were screened by age and Clinical Frailty Score (CFS) for appropriateness and received POPS input based on clinical need. Prior to the POPS team, liaison geriatric input was provided by a sole consultant. Results The 36 patients from the POPS group had an average LOS of 15.9 days, which was significantly lower than the LOS of 37.4 days in the 537 patients in the pre-POPS group (p < 0.01). There were no significant differences in demographics between the two groups. Conclusions The implementation of a POPS team significantly reduced length of stay in older surgical patients.

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Modified 5-Item Frailty Index Is Far More Predictive of Postoperative Adverse Outcomes than 14-Item Risk Analysis Index among Vascular Surgery Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.706 ◽

2020 ◽

Vol 231 (4) ◽

pp. S348

Author(s):

Mohamed S. Zaghloul ◽

Efthymios D. Avgerinos ◽

Michel S. Makaroun ◽

Mohammad H. Eslami

Keyword(s):

Risk Analysis ◽

Vascular Surgery ◽

Frailty Index ◽

Adverse Outcomes

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A prospective investigation of depression and adverse outcomes in patients undergoing vascular surgical interventions: A retrospective cohort study using a large mental health database in South London

European Psychiatry ◽

10.1192/j.eurpsy.2021.2 ◽

2021 ◽

Vol 64 (1) ◽

Author(s):

Sajini Kuruppu ◽

Marvey Ghani ◽

Megan Pritchard ◽

Matthew Harris ◽

Ruwan Weerakkody ◽

...

Keyword(s):

Vascular Surgery ◽

Health Outcomes ◽

Hospital Readmissions ◽

Mental Healthcare ◽

Length Of Hospital Stay ◽

Emergency Admission ◽

Adverse Outcomes ◽

Inpatient Mortality ◽

Surgical Interventions ◽

Emergency Readmission

Abstract Background Patients with depression are more susceptible to cardiovascular illness including vascular surgeries. However, health outcomes after vascular surgery among patients with depression is unknown. This study aimed to investigate associations of depression with post-operative health outcomes for vascular surgical patients. Methods A retrospective observational study was conducted using data from a large mental healthcare provider and linked national hospitalization data for the same south London geographic catchment. OPCS-4 codes were used to identify vascular procedures. Health outcomes were compared between those with/without depression including length of hospital stay (LOS), inpatient mortality, and 30 day emergency hospital readmissions. Predictors of these health outcomes were also assessed. Results Vascular surgery was received by 9,267 patients, including 446 diagnosed with depression. Patients with depression had a higher risk of emergency admission for vascular surgery (odds ratio [OR] 1.28; 1.03, 1.59), longer index LOS (IRR 1.38; 1.33–1.42), and a higher risk of 30-day emergency readmission (OR 1.82; 1.35–2.47). Patients with depression had higher inpatient mortality after adjustment for sociodemographic status (1.51; 1.03, 2.23) but not on full adjustment, and had longer emergency readmission LOS (1.13; 1.04, 1.22) after adjustment for sociodemographic factors and cardiovascular disease. Correlates of vascular surgery hospitalization among patients with depression included admission through emergency route for longer LOS, inpatient mortality, and 30-day hospital readmission. Conclusion Patients with depression undergoing vascular surgery have substantially poorer health outcomes. Screening for depression prior to surgery might be indicated to target preventative measures.

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EP.FRI.997 Recognising frailty: the scale of the problem

British Journal of Surgery ◽

10.1093/bjs/znab312.143 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Laura Martin ◽

Susan Chapman ◽

Elizabeth Broadbent ◽

Christopher Payne ◽

Christina Beecroft

Keyword(s):

Vascular Surgery ◽

Age Groups ◽

Surgical Patient ◽

Staff Education ◽

Clinical Frailty Scale ◽

Frailty Assessment ◽

Surgical Unit ◽

Surgical Admission ◽

Frailty Score ◽

Frailty Criteria

Abstract Aim To assess compliance with frailty scoring in acute surgical admissions. Method Data including age, admitting speciality, whether the frailty score was completed and the recorded score if completed, were collected for all admissions to an acute surgical unit over a 7 day period in November 2019. Results The average age of the 139 patients was 56.25 years (range 16-89). Frailty scoring was completed in 53 patients (38.1%); 8 patients (15%) met the criteria for frailty. Sixty-four patients (46%) were aged over 65 years, 26 (40.6%) had the score completed and 7 (27%) met the frailty criteria. Of 36 patients (26%) aged 75 or over, 16 (44.4%) were scored and 6 (37.5%) met the frailty criteria. Scoring was most frequently completed in patients admitted under the Vascular Surgery team (52.9% compliance) with a mean score 3.8. Conclusion Worsening frailty is associated with increased morbidity and mortality in acute surgical admissions. The 7-point Clinical Frailty Scale has been added our acute surgical admission document and should be completed for every patient. Our compliance with scoring is a long way from our recommended 100%, with compliance with assessing frailty across age groups similar, despite the increased rates of frailty seen in older age groups. Poor compliance with frailty assessment may hamper future progress with the management of the frail, older surgical patient. We are planning documentation changes, staff education sessions and to appoint frailty ‘champions’ with a repeat audit of compliance to assess the effects of these changes.

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