Department of Vascular Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Am Surg. 2023 Nov;89(11):4501-4507. doi: 10.1177/00031348221121547. Epub 2022 Aug 16.
Frailty is associated with adverse surgical outcomes including post-operative complications, needs for post-acute care, and mortality. While multiple frailty screening tools exist, most are time and resource intensive. Here we examine the association of an automated electronic frailty index (eFI), derived from routine data in the Electronic Health Record (EHR), with outcomes in vascular surgery patients undergoing open, lower extremity revascularization.
A retrospective analysis at a single academic medical center from 2015 to 2019 was completed. Information extracted from the EHR included demographics, eFI, comorbidity, and procedure type. Frailty status was defined as fit (eFI≤0.10), pre-frail (0.10<eFI≤0.21), and frail (eFI>0.21). Outcomes included length of stay (LOS), 30-day readmission, and non-home discharge.
We included 295 patients (mean age 65.9 years; 31% female), with the majority classified as pre-frail (57%) or frail (32%). Frail patients exhibited a higher degree of comorbidity and were more likely to be classified as American Society of Anesthesiologist class IV (frail: 46%, pre-frail: 27%, and fit: 18%, P = 0.0012). There were no statistically significant differences in procedure type, LOS, or 30-day readmissions based on eFI. Frail patients were more likely to expire in the hospital or be discharged to an acute care facility (31%) compared to pre-frail (14%) and fit patients (15%, P = 0.002). Adjusting for comorbidity, risk of non-home discharge was higher comparing frail to pre-frail patients (OR 3.01, 95% CI 1.40-6.48).
Frail patients, based on eFI, undergoing elective, open, lower extremity revascularization were twice as likely to not be discharged home.
衰弱与不良手术结果相关，包括术后并发症、对急性后护理的需求和死亡率。虽然有多种衰弱筛查工具，但大多数都需要大量的时间和资源。在这里，我们研究了从电子病历（EHR）中的常规数据中得出的自动电子衰弱指数（eFI）与接受开放性下肢血运重建的血管外科患者结局之间的关联。
对 2015 年至 2019 年期间在一家学术医疗中心进行的回顾性分析。从 EHR 中提取的信息包括人口统计学资料、eFI、合并症和手术类型。衰弱状态定义为健康（eFI≤0.10）、虚弱前期（0.10<eFI≤0.21）和衰弱（eFI>0.21）。结局包括住院时间（LOS）、30 天再入院和非家庭出院。
我们纳入了 295 名患者（平均年龄 65.9 岁；31%为女性），其中大多数为虚弱前期（57%）或衰弱（32%）。虚弱患者的合并症程度更高，更有可能被归类为美国麻醉医师协会 4 级（虚弱：46%，虚弱前期：27%，健康：18%，P=0.0012）。根据 eFI，手术类型、LOS 或 30 天再入院率没有统计学上的显著差异。与虚弱前期（14%）和健康患者（15%）相比，虚弱患者在医院死亡或被送往急性护理机构的可能性更高（31%，P=0.002）。调整合并症后，与虚弱前期患者相比，虚弱患者非家庭出院的风险更高（OR 3.01，95%CI 1.40-6.48）。
根据 eFI，接受择期开放性下肢血运重建的虚弱患者，有两倍的可能无法出院回家。
