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

2021 ◽  
Author(s):  
Sefa Aktı
Keyword(s):  
Prognostic Marker ◽  
Frailty Index ◽  
Ankle Fractures ◽  
Modified Frailty Index

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

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002 ◽  
Author(s):  
Rishin Kadakia ◽  
Jason Bariteau ◽  
Catphuong Vu ◽  
Andrew Pao ◽  
Shay Tenenbaum
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Assessment Tool ◽  
Frailty Index ◽  
Reoperation Rate ◽  
Ankle Fractures ◽  
Postoperative Outcomes ◽  
Improvement Project ◽  
Modified Frailty Index ◽  
Reoperation Rates

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.

scholarly journals Frailty predicts outcome of partial nephrectomy and guides treatment decision towards active surveillance and tumor ablation

2021 ◽  
Author(s):  
M. T. Walach ◽  
M. F. Wunderle ◽  
N. Haertel ◽  
J. K. Mühlbauer ◽  
K. F. Kowalewski ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Surgical Outcome ◽  
Frailty Index ◽  
Treatment Decision ◽  
Solitary Kidney ◽  
Tumor Ablation ◽  
Renal Masses ◽  
Skeletal Muscle Index ◽  
Decision Tools ◽  
Modified Frailty Index

Abstract Purpose To examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA). Methods Frailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with localized renal masses. Renal tumor anatomy was classified according to the RENAL nephrometry system. Regression analyses were performed to assess predictors of surgical outcome of patients undergoing NSS as well as to identify possible influencing factors of patients undergoing alternative therapies (AS/TA). Results Overall 409 patient underwent NSS while 38 received AS or TA. Patients undergoing TA/AS were more likely to be frail or comorbid compared to patients undergoing NSS (aaCCI: p < 0.001, 11-CSHA: p < 0.001). Gender and tumor complexity did not vary between patients of different treatment approach. 11-CSHA and aaCCI were identified as independent predictors of major postoperative complications (11-CSHA ≥ 0.27: OR = 3.6, p = 0.001) and hospital re-admission (aaCCI ≥ 6: OR = 4.93, p = 0.003) in the NSS cohort. No impact was found for albumin levels and SMI. An aaCCI > 6 and/or 11-CSHA ≥ 0.27 (OR = 9.19, p < 0.001), a solitary kidney (OR = 5.43, p = 0.005) and hypoalbuminemia (OR = 4.6, p = 0.009), but not tumor complexity, were decisive factors to undergo AS or TA rather than NSS. Conclusion In patients with localized renal masses, frailty and comorbidity indices can be useful to predict surgical outcome and support decision-making towards AS or TA.

The modified frailty index-11 predicts medium-term outcomes after endovascular revascularisation for chronic limb threatening ischaemia in Asian patients

Vascular ◽  
2021 ◽  
pp. 170853812098822
Author(s):  
Shereen XY Soon ◽  
Reuban D’Çruz ◽  
Charyl JQ Yap ◽  
Wei Ling Tay ◽  
Siew Ping Chng ◽  
...  
Keyword(s):  
Complication Rate ◽  
Early Recognition ◽  
Frailty Index ◽  
Arterial Disease ◽  
Unplanned Readmission ◽  
Medium Term ◽  
Post Intervention ◽  
Asian Patients ◽  
Modified Frailty Index ◽  
The Mean

Objective The aim was to evaluate the utility of frailty, as defined by the modified Frailty Index-1 1 (mFI-11) on predicting outcomes following endovascular revascularisation in Asian patients with chronic limb-threatening ischaemia (CLTI). Methods CLTI patients who underwent endovascular revascularisation between January 2015 and March 2017 were included. Patients were retrospectively scored using the mFI-11 to categorise frailty as low, medium or high risk. Observed outcomes included 30-day complication rate and unplanned readmissions, 1-, 6- and 12-month mortality, and ambulation status at 6- and 12 months post-intervention. Results A total of 233 patients (250 procedures) were included; 137 (58.8%) were males and the mean age was 69.0 (±10.7) years. 202/233 (86.7%) were diabetic and 196/233 (84.1%) had a prior diagnosis of peripheral arterial disease (PAD). The mean mFI-11 score was 4.2 (±1.5). 28/233 (12.0%), 155/233 (66.5%), and 50/233 (21.5%) patients were deemed low (mF-11 score 0–2), moderate (mFI-11 score 3–5) and high (mFI-11 score 5–7) frailty risk, respectively. High frailty was associated with an increased 12-month mortality (OR 8.54, 95% CI 1.05–69.5; p = 0.05), 30-day complication rate (OR 9.41, 95% CI 2.01–44.1; p < 0.01) and 30-day unplanned readmission (OR 5.06, 95% CI 1.06–24.2; p = 0.04). Furthermore, a high score was associated with a significantly worse 6- (OR 0.320, 95% CI 0.120–0.840; p = 0.02) and 12-month (OR 0.270, 95% CI 0.100–0.710; p < 0.01) ambulatory status. Conclusion The mFI-11 is a useful, non-invasive tool that can be readily calculated using readily available patient data, for prediction of medium-term outcomes for Asian CLTI patients following endovascular revascularisation. Early recognition of short- and mid-term loss of ambulation status amongst high-frailty patients in this challenging cohort of patients could aid decision-making for whether a revascularisation or amputation-first policy is appropriate, and manage patient and caregiver expectations on potential improvement in functional outcome.

scholarly journals RR27. Validation of a Modified Frailty Index to Predict Mortality in Vascular Surgery Patients

2015 ◽  
Vol 61 (6) ◽  
pp. 202S
Author(s):  
Bryan A. Ehlert ◽  
Alireza Najafian ◽  
Kristine C. Orion ◽  
Mahmoud B. Malas ◽  
James H. Black ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Frailty Index ◽  
Modified Frailty Index

Modified frailty index predicts postoperative outcomes of spontaneous intracerebral hemorrhage

2018 ◽  
Vol 175 ◽  
pp. 137-143 ◽  
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

scholarly journals Comparison of Sarcopenia with Modified Frailty Index as a Predictor of Adverse Outcomes in Critically Ill Elderly Patients

2021 ◽  
pp. 200-206
Author(s):  
Shrirang Bhurchandi ◽  
Sachin Agrawal ◽  
Sunil Kumar ◽  
Sourya Acharya
Keyword(s):  
Elderly Patients ◽  
Critically Ill ◽  
Health Care Cost ◽  
Frailty Index ◽  
The Elderly ◽  
Time Frame ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Parametric Data ◽  
Modified Frailty Index

Background: Ageing is a global fact affecting both developed and developing countries.It brings out various catabolic changes in body resulting in frailty(i.e. the person is not able to with stand minor stresses of the environment, due to reduced reserves in psychologicalreserve of several organ system).Thus causing a great burden of disease, dependence & health care cost. Sarcopenia is the leading component for frailty in the elderly population, but very few studies have been done in India for correlating frailty with sarcopenia. Aim: To compare sarcopenia with modified frailty index (MFI) as a predictor of adverse outcomes in critically ill elderly patients. Methodology: Cross-sectional study will be performed on all the critically ill geriatric subjects/patients coming to all the ICU's of AVBRH, Sawangi (M), Wardha who will satisfy various inclusion and exclusion criteria for selection and all standard parametric & non-parametric data will be assessed by using standard descriptive & inferential statistics. Expected Results: In our study, we are anticipating that the Modified frailty index to be a better predictor of adverse outcomes in terms of mortality as compared to sarcopenia in the critically ill elderly patients. Also, we are anticipating that sarcopenia to be the most important contributor of frailty in critically ill elderly patients and the prevalence of frailty will be high in critically ill elderly patients. Limitation: Due to limited time frame & resources we will not be able to follow up the 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.

scholarly journals Frailty Predicts Decreased Survival, More Complications, and Higher Hunt & Hess and Fisher Scores Following an Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Matthew McIntyre ◽  
Vikas Patel ◽  
Andrew Long ◽  
Alex Vonhoof ◽  
Boyi Li ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Frailty Index ◽  
Survival Curves ◽  
Rank Analysis ◽  
Frail Patients ◽  
Kaplan Meier ◽  
Discharge Location ◽  
Modified Frailty Index ◽  
To Receive

Abstract INTRODUCTION Aneurysmal SAH (aSAH) is associated with high rates of morbidity and mortality, yet frailty's effect on aSAH outcomes has not been explored. The most common method of measuring frailty is via the modified frailty index (mFI). We hypothesized that increasing frailty is associated with poorer outcomes following an aSAH. METHODS Patients with aSAH were retrospectively identified from angiogram records. The cohort was divided into nonfrail (mFI = 0-1) and frail (mFI = 2) groups based on prehemorrhage characteristics. Primary outcomes were mortality, discharge location, complications (without vasospasm), and vasospasm. Groups were compared using Fishers exact or Mann-Whitney tests, and Kaplan-Meier survival curves were generated for Log-Rank analysis. RESULTS A total of 217 patients with aSAH were identified, 57 of whom were classified as frail (mean mFI = 1.0 ± 0.08). The average Hunt & Hess (HH) and Fisher scores were 2.9 ± 0.09 and 3.7 ± 0.04, respectively. 167 (77%) of patients had = 1 complication, 124 (57.1%) developed vasospasm, but only 41 (18.9%) died, and 74 (34%) were discharged home. Frail patients were significantly older (66 vs 55 yr; P < .0001), had higher rates of hyperlipidemia (OR = 2.2; 95% CI: 1.2-4.3; P = .0219), and had higher HH (P = .005) and Fisher (P = .0255) scores. Frail patients were less likely to receive an intervention (OR = 0.3; 95% CI: 0.1-0.6; P = .0056), less likely to be discharged home (OR = 0.32; 95% CI: 0.16-0.68; P = .0020), had a higher mortality rate (OR = 2.4; 95% CI: 1.2-5; P = .0183), and were more likely develop a complication (OR = 2.6; 95% CI: 1.1-6.6; P = .0277). Log-Rank testing of Kaplan-Meier curves found that frail individuals have a significantly decreased survival compared to non-frail individuals (X2 (1) = 6.939; P = .0084). There were no differences in vasospasm rates between groups. CONCLUSION Frailty is an independent predictor of higher HH and Fisher scores following aSAH, along with lower rates of aneurysm intervention, discharge home, and survival. This relationship has never been demonstrated for aSAH and is valuable for risk stratification and prognostication in aSAH patients.

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