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.

The 5-Factor Modified Frailty Index in the Geriatric Surgical Population

2020 ◽  
pp. 000313482095243
Author(s):  
Sneha Subramaniam ◽  
Jeffrey J. Aalberg ◽  
Rainier P. Soriano ◽  
Celia M. Divino
Keyword(s):  
Predictive Value ◽  
Frailty Index ◽  
Correlation Coefficients ◽  
Predictive Ability ◽  
Improvement Program ◽  
Geriatric Population ◽  
Predictive Values ◽  
Mortality And Morbidity ◽  
Modified Frailty Index ◽  
Factor Index

Background The modified frailty index (mFI-11) is a National Surgical Quality Improvement Program (NSQIP)–based 11-factor index that has been proven to adequately reflect frailty and predict mortality and morbidity. In the past years, certain NSQIP variables have been removed from the database; as of 2015, only 5 out of the original 11 factors remain. While the predictive power and usefulness of this 5-factor index (mFI-5) has been proven in previous work, it has yet to be studied in the geriatrics population. The goal of our study was to compare the mFI-5 to the mFI-11 in terms of value and predictive ability for mortality, postoperative infection, and unplanned 30-day readmission for patients aged 65 years and older. Methods Spearman’s Rho was calculated to compare the value, and unadjusted and adjusted logistic regressions were created for three outcomes in nine surgical subspecialties. Correlation coefficients were above .86 across all surgical specialties except for cardiac surgery. Adjusted and unadjusted models showed similar C-statistics for mFI-5 and 11. Results Overall predictive values of geriatric mFI-5 and mFI-11 were lower than those for the general population but still had effective predictive value for mortality and post-operative complications (C-Stat ≥ .7) and weak predictive value for 30-day readmission. Conclusions The mFI-5 is an equally effective predictor as the mFI-11 in all subspecialties and an effective predictor of mortality and postoperative complication in the geriatric population. This index has credibility for future use to study frailty within NSQIP, within other databases, and for clinical assessment and use.

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.

Association Between 5-Item Modified Frailty Index and Short-term Outcomes in Complex Head and Neck Surgery

2021 ◽  
pp. 019459982110104
Author(s):  
Khodayar Goshtasbi ◽  
Jack L. Birkenbeuel ◽  
Brandon M. Lehrich ◽  
Arash Abiri ◽  
Yarah M. Haidar ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Head And Neck ◽  
Frailty Index ◽  
Medical Complications ◽  
Multivariate Logistic Regression ◽  
Short Term ◽  
Improvement Program ◽  
Acs Nsqip ◽  
Modified Frailty Index ◽  
The Impact

Objectives To evaluate the impact of preoperative frailty on short-term outcomes following complex head and neck surgeries (HNSs). Study Design Cross-sectional database analysis. Setting American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Methods The 2005 to 2017 ACS-NSQIP was queried for patients undergoing complex HNS. Five-item modified frailty index (mFI) was calculated based on functional status and history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and chronic hypertension. Results A total of 2786 patients (73.1% male) with a mean age of 62.0 ± 11.6 years were included. Compared to nonfrail patients (41.2%), patients with mFI ≥1 (58.8%) had shorter length of operation ( P = .021), longer length of stay (LOS) ( P < .001), and higher rates of 30-day reoperation ( P = .009), medical complications ( P < .001), discharge to nonhome facility (DNHF) ( P < .001), and mortality ( P = .047). These parameters remained statistically significant when compared across all individual mFI scores (all P < .05). After adjusting for age, sex, race, body mass index, smoking, and American Society of Anesthesiologists score via multivariate logistic regression, patients with mFI ≥1 were significantly more likely to undergo reoperation (odds ratio [OR], 1.39), surgical complications (OR, 1.19), medical complications (OR, 1.55), prolonged LOS (OR, 1.29), and DNHF (OR, 1.56) (all P < .05). Multivariate logistic regression also demonstrated that after adjusting for confounders, compared to patients with mFI = 1, patients with mFI = 2-5 (18.7%) were more likely to undergo shorter operations (OR, 0.74), have medical (OR, 1.46) or any complications (OR, 1.27), and have DNHF (OR, 1.62) (all P < .05). Conclusion The 5-point mFI can independently predict short-term surgical outcomes following complex HNS. This simple and reliable metric can potentially lead to improved preoperative counseling and postoperative planning for complex HNS patients.

Abstract P301: Evaluating the Impact of a Pharmacist-Managed Hypertension Collaborative Care Model in Vascular Neurology Patients in an Inpatient Acute Care Setting

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ann Smith ◽  
Kathleen Bledsoe ◽  
Thomas Madden ◽  
Jamie Artale ◽  
Ted Sindlinger
Keyword(s):  
Blood Pressure ◽  
Acute Care ◽  
Care Setting ◽  
Management Practice ◽  
Primary Objective ◽  
Adverse Outcomes ◽  
Acute Care Setting ◽  
Percentage Reduction ◽  
Improvement Project ◽  
The Impact

Introduction: The utility of pharmacist-managed collaborative practice agreements (CPA) in the management of hypertension is well established in the outpatient setting. There has been little evaluation of the use of CPAs in the inpatient acute care setting, and none described specifically in the vascular neurology population. Treatment of hypertension is a critical intervention for the secondary prevention of acute ischemic stroke. This quality improvement project evaluated the implementation of a CPA for the inpatient acute care management of hypertension in vascular neurology patients at University of Virginia Health. Methods: A CPA was developed between the neurosciences clinical pharmacist group and the inpatient vascular neurology service, legally vetted, and implemented in June 2019. All vascular neurology patient charts in which an electronic CPA referral was placed from June 2019 through June 2020 were reviewed. Patients were excluded if they were discharged within 24 hours of the referral being placed. The primary objective was to describe and evaluate the implementation of a pharmacist-driven hypertension management practice in the inpatient acute care setting. All patient demographic and clinical data were analyzed using descriptive statistics. Secondary safety outcomes included documented hypotensive events (SBP <90) and acute kidney injury (AKI, increase in SCr by 0.3 mg/dl within 48 hours). Results: During the study period, 26 referrals were placed, and 19 patients were included for review. On average, patients were on 2 anti-hypertensive medications prior to admission. From the time of referral to discharge (mean 6 days), systolic blood pressure (SBP) was reduced on average by 36 mmHg (mean percentage reduction 20%) and diastolic blood pressure (DBP) by 12 mmHg (mean percentage reduction 7%). Ten patients (53%) met the goal of SBP < 140 at discharge. There were 5 hypotensive events and 4 instances of AKI, all of which were mild and recovered prior to discharge. Conclusion: A pharmacist-managed hypertension CPA was successfully implemented in vascular neurology patients in the inpatient acute care setting. The practice demonstrated improved blood pressure control and minimal adverse outcomes.

What factors affect nursing retention in the acute care setting?

2011 ◽  
Vol 16 (6) ◽  
pp. 489-500 ◽  
Author(s):  
Cynthia L. Cummings
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Moral Distress ◽  
Intent To Stay ◽  
Institutional Setting ◽  
Acute Care Setting ◽  
Nursing Retention ◽  
Acute Care Nurses ◽  
Professional Stress ◽  
The Impact

Moral distress and professional stress affect the lives of acute care nurses everyday. The impact of these stressors may be causing nurses to leave the acute care setting. This paper will outline the findings from a descriptive study of acute care nurses in Northeast Florida. The research was conducted in an effort to highlight some of the critical factors that impact nurses in the acute care setting and affect their intent to stay at an institution. The concepts of moral distress and professional stress in relation to nursing retention are highlighted and some strategies for lessening of these stressors are proposed. The study was correlational and conducted among 234 nurses in an institutional setting. The study included an online survey based on established Moral Distress and Professional Stress tools. In addition, a qualitative section was included to explore the nurses’ experiences of stressful inpatient situations. The results of this study demonstrated that when combined, both professional stress and moral distress items were predictive of the nurses’ intent to stay at the institution ( p <.001).

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.

Abstract 186: Improving Identification and Assessment of Readmission Risk for Acute Myocardial Infarction and Heart Failure Patients Following Implementation of a National Quality Improvement Program

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Ty J Gluckman ◽  
Nancy M Albert ◽  
Robert L McNamara ◽  
Gregg C Fonarow ◽  
Adnan Malik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Quality Improvement ◽  
Improvement Program ◽  
Patient Level ◽  
Transition Care ◽  
National Quality ◽  
The Impact ◽  
Readmission Risk

Background: Optimal transition care represents an important step in mitigating the risk of early hospital readmission. For many hospitals, however, resources are not available to support transition care processes, and hospitals may not be able to identify patients in greatest need. It remains unknown whether a coordinated quality improvement campaign could help to increase a) identification of at-risk patients and b) use of a readmission risk score to identify patients needing extra services/resources. Methods: The American College of Cardiology Patient Navigator Program was designed as a 2-year (2015-2017) quality improvement campaign to assess the impact of transition-care interventions on transition care performance metrics for patients with acute myocardial infarction (AMI) and heart failure (HF) at 35 acute care hospitals. All sites were active participants in the NCDR ACTION Registry. Facilities were free to choose their transition care priorities, with at least 3 goals established at baseline. Pre-discharge identification of AMI and HF patients and assessment of their respective readmission risk were 4 of the 36 metrics tracked quarterly. Performance reports were provided regularly to the individual institutions. Sharing of best practices was actively encouraged through webinars, a listserv, and an online dashboard with display of blinded performance for all 35 hospitals. Results: At baseline, 31% (11/35) and 23% (8/35) of facilities did not have a process for prospectively identifying AMI and HF patients, respectively. At 2 years, the rate of not having processes decreased to 8% (3/35) and 3% (1/35), respectively. Among hospitals able to identify AMI and HF patients, there was high patient-level identification performance from the outset (91% for AMI and 86% for HF at baseline), with added improvement over 2 years (+2.2% for AMI and +9.3% for HF). At baseline, processes to assess readmission risk for AMI and HF patients were only completed by 26% (9/35) and 31% (11/35) of facilities, respectively. At 2 years, AMI and HF readmission risk assessment rose to 80% (28/35) and 86% (30/35), respectively. Similar improvements were noted at the patient-level, with 34% (52% --> 86%) and 16% (75% --> 91%) absolute 2-year increases in the percentage of AMI and HF patients undergoing assessment of readmission risk, respectively. Conclusions: Implementation of a quality improvement campaign focused on care transition can substantially improve prospective identification of AMI and HF patients and assessment of their readmission risk. It remains to be determined whether process improvement lead to reduction in 30-day readmission and/or improvement in other clinically important outcome measures.

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