Association of a Modified Frailty Index with Postoperative Outcomes after Ankle Fractures in Patients Aged 50 Years and Older

Category: Ankle, Trauma Introduction/Purpose: Frailty, a multifaceted syndrome resulting from a decrease in physiologic reserves, has been previously shown to play a significant role in elderly morbidity and mortality. The literature on frailty within orthopaedic surgery is limited currently. No study to date has assessed frailty as a predictor of postoperative outcomes in elderly patients with ankle fractures. We hypothesized that increasing frailty would be associated with increased 30-day reoperation rates and increased postoperative complications. Methods: The National Surgical Quality Improvement Project (NSQIP) was queried using the appropriate CPT codes to identify inpatients from 2005-2014 who were aged 50 years and older that sustained an ankle fracture and underwent operative fixation. Frailty was assessed using a modified frailty index (MFI), abbreviated with 11 variables from the Canadian Study of Health and Aging Frailty Index. The primary outcome was 30-day reoperation rate and secondary outcomes were postoperative surgical and medical complications, readmission rates, and length of stay. Bivariate and multivariate analysis was used to determine association between outcomes and MFI. Results: 6,749 patients were identified, and the mean age of these patients was 64.4 years. Patients with increased MFI scores had significantly higher rates of postoperative complications. In addition, increased MFI scores was also associated with increased 30 day readmissions and reoperations. Multivariate analysis also demonstrated that MFI was a stronger predictor of 30 day reoperation rates (odds ratio of 17.7, P < 0.001) than age, wound class, and ASA class. Conclusion: Frailty has the potential to be an important predictive variable of postoperative outcomes in patients aged 50 years and older who sustain ankle fractures. The modified frailty index can be a valuable preoperative risk assessment tool for the orthopaedic surgeon. Further study is necessary to examine the effect of the MFI in a larger prospective setting.

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210. Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool

The Spine Journal ◽

10.1016/j.spinee.2020.05.621 ◽

2020 ◽

Vol 20 (9) ◽

pp. S103-S104

Author(s):

Peter G. Passias ◽

Katherine E. Pierce ◽

Virginie Lafage ◽

Renaud Lafage ◽

Breton Line ◽

...

Keyword(s):

Risk Assessment ◽

Assessment Tool ◽

Frailty Index ◽

Surgical Correction ◽

Risk Assessment Tool ◽

Baseline Risk ◽

Spinal Deformities ◽

Functional Changes ◽

Modified Frailty Index

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Modified frailty index predicts postoperative outcomes of spontaneous intracerebral hemorrhage

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2018.11.004 ◽

2018 ◽

Vol 175 ◽

pp. 137-143 ◽

Cited By ~ 11

Author(s):

Yukihiro Imaoka ◽

Takayuki Kawano ◽

Akihito Hashiguchi ◽

Kenji Fujimoto ◽

Keizou Yamamoto ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Frailty Index ◽

Postoperative Outcomes ◽

Spontaneous Intracerebral Hemorrhage ◽

Modified Frailty Index

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Is the 5-factor Modified Frailty Index a Prognostic Marker in Geriatric Ankle Fractures?

Turkish Journal of Trauma and Emergency Surgery ◽

10.14744/tjtes.2021.08972 ◽

2021 ◽

Author(s):

Sefa Aktı

Keyword(s):

Prognostic Marker ◽

Frailty Index ◽

Ankle Fractures ◽

Modified Frailty Index

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P175 TRANSLATION OF MINIMALLY INVASIVE ESOPHAGECTOMY FROM RANDOMIZED CONTROLLED TRIAL SETTING (TIME) TO NATIONAL PRACTICE (DUCA) IN NETHERLANDS

Diseases of the Esophagus ◽

10.1093/dote/doz092.175 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

R Markar Sheraz ◽

Ni Melody ◽

Gisbertz Suzanne ◽

Straatman Jennifer ◽

van der Peet Donald ◽

...

Keyword(s):

Multivariate Analysis ◽

Postoperative Complications ◽

Minimally Invasive ◽

Hospital Stay ◽

Minimally Invasive Esophagectomy ◽

Univariate Analysis ◽

Length Of Hospital Stay ◽

Time Trial ◽

Reoperation Rate ◽

Invasive Esophagectomy

Abstract Aims The TIME trial showed reduced pulmonary complications from minimally invasive esophagectomy (MIE) over an open approach, and led to widespread adoption of MIE in the Netherlands. The aim of this study was to compare clinical outcomes from minimally invasive esophagectomy in the DUCA (national dataset) and the TIME trial (RCT) for transthoracic esophagectomy1. Methods Original patient data from the TIME trial1 was extracted along-with data from the Dutch National Cancer Audit (DUCA) (2011-2017). Initially univariate analysis was used to compare patient and tumor demographics and clinical and pathological outcomes from patients receiving MIE in the TIME trial and in the DUCA-dataset. Secondly multivariate analysis, with adjustment patient and tumor factors, was performed for the effect of MIE vs. Open esophagectomy on clinical outcomes in both datasets. Thirdly the datasets were combined and multivariate analysis, was performed for the effect of patient inclusion in TIME trial or DUCA-dataset. Results 115 patients from TIME (59 MIE vs. 56 open) and 4605 patients from the DUCA-dataset (2652 MIE vs. 1953 open) were included. Univariate analysis showed, in TIME trial, MIE reduced postoperative complications and length of hospital stay. However in the DUCA-dataset, MIE increased postoperative complications, re-intervention rate and length of hospital stay, however pathological benefits included increased proportion of R0 margin and lymph nodes harvested. Multivariate analysis confirmed the TIME data showed MIE reduced postoperative complications (OR=0.38, 95%CI 0.16–0.90). In the DUCA-dataset, MIE was associated with increased postoperative complications (OR=1.37, 95%CI 1.20–1.55), re-intervention (OR=1.84, 95%CI 1.57–2.14), and length of hospital stay (Coeff=1.57, 95%CI 0.06–3.08). Pathological benefits to MIE in the DUCA-dataset included a reduction in proportion of R1 margin, and increased lymph node harvest. Multivariate analysis of the combined dataset, showed inclusion in the TIME trial was associated with a reduction in postoperative complications (OR=0.23, 95%CI 0.15–0.36) and reoperation rate (OR=0.34, 95%CI 0.17–0.66). Conclusions MIE when adopted nationally outside the TIME-trial, was associated with an increase in postoperative complications and reoperation rate, which may reflect surgeons on a national level going through their proficiency-gain curve in the technique and outside of expert MIE centers.

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Using the modified frailty index to predict negative outcomes in free‐flap breast reconstruction: A National Surgical Quality Improvement Project ‐based study

Microsurgery ◽

10.1002/micr.30810 ◽

2021 ◽

Author(s):

Nirbhay S. Jain ◽

Linh N. Vuong ◽

L. Brian Hickman ◽

Patrick Chin ◽

Elspeth J. R. Hill ◽

...

Keyword(s):

Quality Improvement ◽

Breast Reconstruction ◽

Free Flap ◽

Frailty Index ◽

Quality Improvement Project ◽

Negative Outcomes ◽

Surgical Quality ◽

Improvement Project ◽

Modified Frailty Index

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Use of a Modified Frailty Index as a Preoperative Assessment Tool for Patients Undergoing Fixation of Long Bone Fractures

10.26226/morressier.5cffabaef6074e97f94aae7a ◽

2019 ◽

Author(s):

Dominick Congiusta ◽

Shannen Mulles ◽

Irfan Ahmed ◽

Michael Vosbikian

Keyword(s):

Assessment Tool ◽

Bone Fractures ◽

Frailty Index ◽

Preoperative Assessment ◽

Long Bone ◽

Long Bone Fractures ◽

Modified Frailty Index

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Preoperative Controlling Nutritional Status (CONUT) Score Predicts Short-Term Surgical Prognosis in Patients with Gastric Cancer After Laparoscopy-Assisted Radical Gastrectomy

10.21203/rs.3.rs-53990/v1 ◽

2020 ◽

Author(s):

Yun Qian ◽

Huaying Liu ◽

Junhai Pan ◽

Weihua Yu ◽

Jiemin Lv ◽

...

Keyword(s):

Gastric Cancer ◽

Multivariate Analysis ◽

Postoperative Complications ◽

Nutritional Status ◽

Assessment Tool ◽

Predictive Ability ◽

Short Term ◽

Optimal Cutoff ◽

Cutoff Value ◽

Conut Score

Abstract Background: The Controlling Nutritional Status (CONUT) score is an emerging nutrition assessment tool that is very useful in patients with gastric cancer who usually experience weight loss and malnutrition. The aim of our study was to assess the predictive ability of the preoperative CONUT score for short-term prognosis in patients with gastric cancer undergoing laparoscopy-assisted gastrectomy.Methods: We retrospectively reviewed medical records of 309 patients who underwent curative laparoscopy-assisted gastrectomy. The patients were divided into two groups according to the optimal cutoff value of the CONUT score. The clinical association for the CONUT score, characteristics, and postoperative complications were evaluated and analyzed. The risk factors for complications were identified by univariate and multivariate analysis.Results: The preoperative CONUT score showed a good predictive ability for postoperative complications (AUC=0.718，Youden index=0.343)，with an optimal cutoff value of 2.5. The patients with high CONUT scores had a higher incidence of overall complications (P<0.001) and mild complications (P<0.001). Univariate and multivariate analysis revealed that the CONUT score was independently associated with postoperative complications (P=0.012；OR=2.433；95%CI：1.218-4.862).Conclusions：The preoperative CONUT score was identified as a reliable nutritional assessment tool for predicting short-term prognosis in patients with gastric cancer after laparoscopy-assisted gastrectomy.

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Novel bypass risk predictive tool is superior to the 5-Factor Modified Frailty Index in predicting postoperative outcomes

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.11.050 ◽

2020 ◽

Vol 72 (4) ◽

pp. 1427-1435.e1

Author(s):

Zein M. Saadeddin ◽

Jeffrey D. Borrebach ◽

Jacob C. Hodges ◽

Efthymios D. Avgerinos ◽

Michael Singh ◽

...

Keyword(s):

Frailty Index ◽

Postoperative Outcomes ◽

Predictive Tool ◽

Modified Frailty Index

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

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.418 ◽

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.

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