Department of Surgery, Baylor Scott & White Memorial Hospital, Temple, TX.
Department of Surgery, Baylor Scott & White Memorial Hospital, Temple, TX.
J Am Coll Surg. 2019 Apr;228(4):482-490. doi: 10.1016/j.jamcollsurg.2018.12.036. Epub 2019 Mar 1.
Frailty is an emerging risk factor for surgical outcomes; however, its application across large populations is not well defined. We hypothesized that frailty affects postoperative outcomes in a large health care system.
Frailty was prospectively measured in elective surgery patients (January 2016 to June 2017) in a health care system (4 hospitals/901 beds). Frailty classifications-low (0), intermediate (1 to 2), high (3 to 5)-were assigned based on the modified Hopkins score. Operations were classified as inpatient (IP) vs outpatient (OP). Outcomes measured (30-day) included major morbidity, discharge location, emergency department (ED) visit, readmission, length of stay (LOS), mortality, and direct-cost/patient.
There were 14,530 elective surgery patients (68.1% outpatient, 31.9% inpatient) preoperatively assessed (cardiothoracic 4%, colorectal 4%, general 29%, oral maxillofacial 2%, otolaryngology 8%, plastic surgery 13%, podiatry 6%, surgical oncology 5%, transplant 3%, urology 24%, vascular 2%). High frailty was found in 3.4% of patients (5.3% IP, 2.5% OP). Incidence of major morbidity, readmission, and mortality correlated with frailty classification in all patients (p < 0.05). In the IP cohort, length of stay in days (low 1.6, intermediate 2.3, high 4.1, p < 0.0001) and discharge to facility increased with frailty (p < 0.05). In the OP cohort, ED visits increased with frailty (p < 0.05). Frailty was associated with increased direct-cost in the IP cohort (low, $7,045; intermediate, $7,995; high, $8,599; p < 0.05).
Frailty affects morbidity, mortality, and health care resource use in both IP and OP operations. Additionally, IP cost increased with frailty. The broad applicability of frailty (across surgical specialties) represents an opportunity for risk stratification and patient optimization across a large health care system.
衰弱是手术结果的一个新兴风险因素；然而，其在大量人群中的应用尚未得到明确界定。我们假设衰弱会影响大型医疗保健系统中的术后结果。
在医疗保健系统（4 家医院/901 张床位）中，对 2016 年 1 月至 2017 年 6 月的择期手术患者进行衰弱前瞻性测量。根据改良霍普金斯评分，将衰弱分类为低（0）、中（1-2）、高（3-5）。手术分为住院（IP）和门诊（OP）。在 30 天内测量了主要发病率、出院地点、急诊（ED）就诊、再入院、住院时间（LOS）、死亡率和每位患者的直接费用。
共有 14530 名择期手术患者（68.1%为门诊患者，31.9%为住院患者）接受术前评估（心胸科 4%，结直肠科 4%，普通外科 29%，口腔颌面外科 2%，耳鼻喉科 8%，整形外科 13%，足病学 6%，肿瘤外科 5%，移植 3%，泌尿科 24%，血管外科 2%）。高虚弱患者占 3.4%（住院患者 5.3%，门诊患者 2.5%）。所有患者的主要发病率、再入院率和死亡率均与虚弱分类相关（p<0.05）。在住院患者队列中，住院天数（低 1.6 天，中 2.3 天，高 4.1 天，p<0.0001）和设施出院率随虚弱程度增加而增加（p<0.05）。在门诊患者队列中，ED 就诊次数随虚弱程度增加而增加（p<0.05）。在住院患者队列中，虚弱与直接费用增加相关（低 7045 美元，中 7995 美元，高 8599 美元，p<0.05）。
衰弱会影响住院和门诊手术的发病率、死亡率和医疗资源利用。此外，住院费用随虚弱程度增加而增加。衰弱在多个外科专业中的广泛适用性代表了在大型医疗保健系统中进行风险分层和患者优化的机会。
