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Forssten MP, Cao Y, Mohammad Ismail A, Tennakoon L, Spain DA, Mohseni S. Comparative Analysis of Frailty Scores for Predicting Adverse Outcomes in Hip Fracture Patients: Insights from the United States National Inpatient Sample. J Pers Med 2024; 14:621. [PMID: 38929842 PMCID: PMC11204756 DOI: 10.3390/jpm14060621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
The aim of the current investigation was to compare the ability of several frailty scores to predict adverse outcomes in hip fracture patients. All adult patients (18 years or older) who suffered a hip fracture due to a fall and underwent surgical fixation were extracted from the 2019 National Inpatient Sample (NIS) Database. A combination of logistic regression and bootstrapping was used to compare the predictive ability of the Orthopedic Frailty Score (OFS), the Nottingham Hip Fracture Score (NHFS), the 11-factor modified Frailty Index (11-mFI) and 5-factor (5-mFI) modified Frailty Index, as well as the Johns Hopkins Frailty Indicator. A total of 227,850 patients were extracted from the NIS. In the prediction of in-hospital mortality and failure-to-rescue (FTR), the OFS surpassed all other frailty measures, approaching an acceptable predictive ability for mortality [AUC (95% CI): 0.69 (0.67-0.72)] and achieving an acceptable predictive ability for FTR [AUC (95% CI): 0.70 (0.67-0.72)]. The NHFS demonstrated the highest predictive ability for predicting any complication [AUC (95% CI): 0.62 (0.62-0.63)]. The 11-mFI exhibited the highest predictive ability for cardiovascular complications [AUC (95% CI): 0.66 (0.64-0.67)] and the NHFS achieved the highest predictive ability for delirium [AUC (95% CI): 0.69 (0.68-0.70)]. No score succeeded in effectively predicting venous thromboembolism or infections. In summary, the investigated frailty scores were most effective in predicting in-hospital mortality and failure-to-rescue; however, they struggled to predict complications.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro 701 82, Sweden
- School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden;
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, 701 82 Orebro, Sweden;
| | | | - Lakshika Tennakoon
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (L.T.); (D.A.S.)
| | - David A. Spain
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (L.T.); (D.A.S.)
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden;
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi P.O. Box 11001, United Arab Emirates
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Balian J, Sakowitz S, Verma A, Vadlakonda A, Cruz E, Ali K, Benharash P. Machine learning based predictive modeling of readmissions following extracorporeal membrane oxygenation hospitalizations. Surg Open Sci 2024; 19:125-130. [PMID: 38655069 PMCID: PMC11035075 DOI: 10.1016/j.sopen.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
Background Despite increasing utilization and survival benefit over the last decade, extracorporeal membrane oxygenation (ECMO) remains resource-intensive with significant complications and rehospitalization risk. We thus utilized machine learning (ML) to develop prediction models for 90-day nonelective readmission following ECMO. Methods All adult patients receiving ECMO who survived index hospitalization were tabulated from the 2016-2020 Nationwide Readmissions Database. Extreme Gradient Boosting (XGBoost) models were developed to identify features associated with readmission following ECMO. Area under the receiver operating characteristic (AUROC), mean Average Precision (mAP), and the Brier score were calculated to estimate model performance relative to logistic regression (LR). Shapley Additive Explanation summary (SHAP) plots evaluated the relative impact of each factor on the model. An additional sensitivity analysis solely included patient comorbidities and indication for ECMO as potential model covariates. Results Of ∼22,947 patients, 4495 (19.6 %) were readmitted nonelectively within 90 days. The XGBoost model exhibited superior discrimination (AUROC 0.64 vs 0.49), classification accuracy (mAP 0.30 vs 0.20) and calibration (Brier score 0.154 vs 0.165, all P < 0.001) in predicting readmission compared to LR. SHAP plots identified duration of index hospitalization, undergoing heart/lung transplantation, and Medicare insurance to be associated with increased odds of readmission. Upon sub-analysis, XGBoost demonstrated superior disclination compared to LR (AUROC 0.61 vs 0.60, P < 0.05). Chronic liver disease and frailty were linked with increased odds of nonelective readmission. Conclusions ML outperformed LR in predicting readmission following ECMO. Future work is needed to identify other factors linked with readmission and further optimize post-ECMO care among this cohort.
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Affiliation(s)
- Jeffrey Balian
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Emma Cruz
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
- Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, CA, United States of America
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Sakowitz S, Bakhtiyar SS, Curry J, Mallick S, Vadlakonda A, Ali K, Sanaiha Y, Benharash P. Off-Pump Coronary Artery Bypass Grafting Does Not Confer Superior Outcomes Among Frail Patients. Am J Cardiol 2024; 220:16-22. [PMID: 38527578 DOI: 10.1016/j.amjcard.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/17/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
Off-pump coronary revascularization (OPCAB) has been proposed to benefit patients who are at a greater surgical risk because it avoids the use of extracorporeal circulation. Although, historically, older patients were considered high-risk candidates, recent studies implicate frailty as a more comprehensive measure of perioperative fitness. Yet, the outcomes of OPCAB in frail patients have not been elucidated. Thus, using a national cohort of frail patients, we assessed the impact of OPCAB relative to on-pump coronary revascularization (ONCAB). Patients who underwent first-time elective coronary revascularization were tabulated from the 2010 to 2020 Nationwide Readmissions Database. Frailty was assessed using the previously-validated Johns Hopkins Adjusted Clinical Groups indicator. Multivariable models were used to consider the independent associations between OPCAB and the key outcomes. Of ∼26,529 frail patients, 6,322 (23.8%) underwent OPCAB. After risk adjustment and compared with ONCAB, OPCAB was linked with similar odds of in-hospital mortality but greater likelihood of postoperative cardiac arrest (adjusted odds ratio [AOR] 1.53, confidence interval [CI] 1.13 to 2.07) and myocardial infarction (AOR 1.44, CI 1.23 to 1.69). OPCAB was further associated with greater odds of postoperative infection (AOR 1.22, CI 1.02 to 1.47) but decreased need for blood transfusion (AOR 0.68, CI 0.60 to 0.77). In addition, OPCAB faced a +0.86-day increase in length of stay (CI 0.21 to 1.51) but similar costs (β $1,610, CI -$1,240 to 4,460) relative to ONCAB. Although OPCAB was associated with no difference in mortality compared with ONCAB, it was linked with greater likelihood of postoperative cardiac arrest and myocardial infarction. Our findings demonstrate that ONCAB remains associated with superior outcomes, even in the growing population of frail patients who underwent coronary revascularization.
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Affiliation(s)
- Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California; Department of Surgery, University of Colorado, Aurora, Colorado
| | - Joanna Curry
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California; Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California, Los Angeles, California; Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, California.
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Pergolotti M, Wood KC, Hidde M, Kendig TD, Ronnen EA, Giri S, Williams GR. Geriatric assessment-identified impairments and frailty in adults with cancer younger than 65: An opportunity to optimize oncology care. J Geriatr Oncol 2024; 15:101751. [PMID: 38569461 DOI: 10.1016/j.jgo.2024.101751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Frailty, a state of increased vulnerability to stressors due to aging or treatment-related accelerated aging, is associated with declines in physical, cognitive and/or social functioning, and quality of life for cancer survivors. For survivors aged <65 years, little is known about frailty status and associated impairments to inform intervention. We aimed to evaluate the prevalence of frailty and contributing geriatric assessment (GA)-identified impairments in adults aged <65 versus ≥65 years with cancer. MATERIALS AND METHODS This study is a secondary analysis of clinical trial data (NCT04852575). Participants were starting a new line of systemic therapy at a community-based oncology private practice. Before starting treatment, participants completed an online patient-reported GA and the Physical Activity (PA) Vital Sign questionnaire. Frailty score and category were derived from GA using a validated deficit accumulation model: frail (>0.35), pre-frail (0.2-0.35), or robust (0-0.2). PA mins/week were calculated, and participants were coded as either meeting/not-meeting guidelines (≥90 min/week). We used Spearman (ρ) correlation to examine the association between age and frailty score and chi-squared/Fisher's-exact or ANOVA/Kruskal-Wallis statistic to compare frailty and PA outcomes between age groups. RESULTS Participants (n = 96) were predominantly female (62%), Caucasian (68%), beginning first-line systemic therapy (69%), and 1.75 months post-diagnosis (median). Most had stage III to IV disease (66%). Common cancer types included breast (34%), gastrointestinal (23%), and hematologic (15%). Among participants <65, 46.8% were frail or pre-frail compared to 38.7% of those ≥65. There was no association between age and frailty score (ρ = 0.01, p = 0.91). Between age groups, there was no significant difference in frailty score (p = 0.95), the prevalence of frailty (p = 0.68), number of GA impairments (p = 0.33), or the proportion meeting PA guidelines (p = 0.72). However, older adults had more comorbid conditions (p = 0.03) and younger adults had non-significant but clinically relevant differences in functional ability, falls, and PA level. DISCUSSION In our cohort, the prevalence of frailty was similar among adults with cancer <65 when compared to those older than 65, however, types of GA impairments differed. These results suggest GA and the associated frailty index could be useful to identify needs for intervention and inform clinical decisions during cancer treatment regardless of age. Additional research is needed to confirm our findings.
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Affiliation(s)
- Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, United States of America; University of North Carolina at Chapel Hill, NC, United States of America
| | - Kelley C Wood
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, United States of America.
| | - Mary Hidde
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, United States of America; Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Tiffany D Kendig
- ReVital Cancer Rehabilitation, Select Medical, Mechanicsburg, PA, United States of America
| | - Ellen A Ronnen
- Astera Cancer Care, East Brunswick, NJ, United States of America
| | - Smith Giri
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, United States of America
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Mohseni S, Forssten MP, Mohammad Ismail A, Cao Y, Hildebrand F, Sarani B, Ribeiro MAF. Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures. Trauma Surg Acute Care Open 2024; 9:e001206. [PMID: 38347893 PMCID: PMC10860062 DOI: 10.1136/tsaco-2023-001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Studies have shown an increased risk of morbidity in elderly patients suffering rib fractures from blunt trauma. The association between frailty and rib fractures on adverse outcomes is still ill-defined. In the current investigation, we sought to delineate the association between frailty, measured using the Orthopedic Frailty Score (OFS), and outcomes in geriatric patients with isolated rib fractures. Methods All geriatric (aged 65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement database with a conservatively managed isolated rib fracture were considered for inclusion. An isolated rib fracture was defined as the presence of ≥1 rib fracture, a thorax Abbreviated Injury Scale (AIS) between 1 and 5, an AIS ≤1 in all other regions, as well as the absence of pneumothorax, hemothorax, or pulmonary contusion. Based on patients' OFS, patients were classified as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The prevalence ratio (PR) of composite complications, in-hospital mortality, failure-to-rescue (FTR), and intensive care unit (ICU) admission between the OFS groups was determined using Poisson regression models to adjust for potential confounding. Results A total of 65 375 patients met the study's inclusion criteria of whom 60% were non-frail, 29% were pre-frail, and 11% were frail. There was a stepwise increased risk of complications, in-hospital mortality, and FTR from non-frail to pre-frail and frail. Compared with non-frail patients, frail patients exhibited a 87% increased risk of in-hospital mortality [adjusted PR (95% CI): 1.87 (1.52-2.31), p<0.001], a 44% increased risk of complications [adjusted PR (95% CI): 1.44 (1.23-1.67), p<0.001], a doubling in the risk of FTR [adjusted PR (95% CI): 2.08 (1.45-2.98), p<0.001], and a 17% increased risk of ICU admission [adjusted PR (95% CI): 1.17 (1.11-1.23), p<0.001]. Conclusion There is a strong association between frailty, measured using the OFS, and adverse outcomes in geriatric patients managed conservatively for rib fractures.
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Affiliation(s)
- Shahin Mohseni
- Orebro universitet Fakulteten for medicin och halsa, Orebro, Sweden
- Department of Surgery, Sheikh Shakhbout Medical City—Mayo Clinic, Abu Dhabi, UAE
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Babak Sarani
- George Washington University, Washington, District of Columbia, USA
| | - Marcelo AF Ribeiro
- Department of Surgery, Sheikh Shakhbout Medical City—Mayo Clinic, Abu Dhabi, UAE
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Palmer AD, Starmer H, Sathe N, Yao TJ, Bolognone RK, Edwards J, Crino C, Kizner J, Graville DJ. Use of the G8 Geriatric Screening Tool in Surgical Head and Neck Cancer Patients Requiring Rehabilitation: A Multisite Investigation. Ann Otol Rhinol Laryngol 2024; 133:158-168. [PMID: 37551009 DOI: 10.1177/00034894231191869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The G8 is a well-validated screening test for older cancer patients. The current study was undertaken to determine whether the G8 is predictive of short-term post-operative outcomes after head and neck cancer (HNC) surgery. METHODS Consecutive patients aged 65 years or more and referred for a preoperative assessment by a speech-language pathologist were consecutively screened by clinicians at 2 academic medical centers using the G8. The G8 was used to screen for vulnerability prior to surgery. Patients were deemed vulnerable if they had a total G8 score ≤14 according to published guidelines. Data were also collected on demographic characteristics, tumor staging, post-operative course, and tracheostomy and feeding tube (FT) status. RESULTS Ninety patients were consecutively screened during the study period. Using the G8, 64% of the patients were deemed vulnerable. Vulnerable patients differed significantly from non-vulnerable patients with regard to age, health, tumor stage, and baseline dysphagia, and underwent more extensive surgery. Postoperatively, vulnerable patients had a significantly longer hospital length of stay (LOS; 10.17 vs 5.50 days, respectively, P < .001), were less likely to discharge home (76% vs 94%, P = .044), and were more likely to be FT dependent for over a month (54% vs 21%, P = .006) compared to non-vulnerable patients. In regression models, controlling for T-stage and surgical variables, the G8 independently predicted 2 post-operative outcomes of interest, namely LOS and FT dependency. CONCLUSIONS The G8 may be a useful screening tool for identifying older adults at risk of a protracted postoperative medical course after HNC surgery. Future research should aim to identify the optimal screening protocol and how this information can be incorporated into clinical pathways to enhance the post-operative outcomes of older HNC patients.
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Affiliation(s)
- Andrew D Palmer
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Heather Starmer
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, CA, USA
| | - Nishad Sathe
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Theresa Jingyun Yao
- Head and Neck Speech and Swallowing Rehabilitation Center, Stanford Healthcare, Stanford, CA USA
| | - Rachel K Bolognone
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jeffrey Edwards
- Head and Neck Speech and Swallowing Rehabilitation Center, Stanford Healthcare, Stanford, CA USA
| | - Carrie Crino
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer Kizner
- Head and Neck Speech and Swallowing Rehabilitation Center, Stanford Healthcare, Stanford, CA USA
| | - Donna J Graville
- Northwest Center for Voice & Swallowing, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
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Mallick S, Sakowitz S, Bakhtiyar SS, Chervu N, Valenzuela A, Kim S, Benharash P. Administrative coding of frailty: Its association with clinical outcomes and resource use in kidney transplantation. Clin Transplant 2024; 38:e15200. [PMID: 38041448 DOI: 10.1111/ctr.15200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Although not formalized into current risk assessment models, frailty has been associated with negative postoperative outcomes in many specialties. However, national analyses of the association between frailty and post-transplant outcomes following kidney transplantation (KT) are lacking. METHODS This was a retrospective cohort study of adults undergoing KT from 2016 to 2020 in the Nationwide Readmissions Databases. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator. RESULTS Of an estimated 95 765 patients undergoing KT during the study period, 4918 (5.1%) were frail. After risk adjustment, frail patients were associated with significantly higher odds of in-hospital mortality (AOR 2.17, 95% CI: 1.33-3.57) compared to their non-frail counterparts. Our findings indicate that frail patients had an average increase in postoperative hospital stay of 1.44 days, a $2300 increase in hospitalization costs, as well as higher odds of developing a major perioperative complication as compared to their non-frail counterparts. Frailty was also associated with greater adjusted risk of non-home discharge. CONCLUSIONS Frailty, as identified by administrative coding, is independently associated with worse surgical outcomes, including increased mortality and resource use, in adults undergoing KT. Given the already limited donor organ pool, novel efforts are needed to ensure adequate optimization and timely post-transplantation care of the growing frail cohort undergoing KT.
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Affiliation(s)
- Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Alberto Valenzuela
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Rangwala SD, Han JS, Lamorie-Foote K, Ding L, Giannotta SL, Attenello FJ, Mack W. Frailty is a Predictor of Increased Readmissions and Increased Postoperative Complications After Elective Treatment of Unruptured Aneurysms. World Neurosurg 2024; 181:e882-e896. [PMID: 37944858 DOI: 10.1016/j.wneu.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Frailty is a state of decreased physiologic reserve associated with adverse treatment outcomes across surgical specialties. We sought to determine whether frailty affected patient outcomes after elective treatment (open microsurgical clipping or endovascular therapy [EVT]) of unruptured cerebral aneurysms (UCAs). METHODS The National Readmissions Database was queried from 2010 to 2014 to identify patients who had a known UCA and underwent elective clipping or EVT. Frailty was assessed using the Johns Hopkins Adjusted Clinical Groups frailty indicator tool. Multivariable exact logistic regression analyses were conducted to assess the associations between frailty and the primary outcome variables of 30- and 90-day readmissions, complications, length of stay (LOS), and patient disposition. RESULTS Of 18,483 patients who underwent elective treatment for UCAs, 358 (1.9%) met the criteria for frailty. After adjusting for patient- and hospital-based factors, frailty (30-day: odds ratio [OR], 1.55; 95% confidence interval [CI], 1.11-2.17; P = 0.01; 90-day: OR, 1.47; 95% CI, 1.05-2.06; P = 0.02) and clipping versus EVT (30-day: OR, 2.12; 95% CI, 1.85-2.43; P < 0.000; 90-day: OR, 1.80; 95% CI, 1.59-2.03; P < 0.0001) were associated with increased readmission rates. Furthermore, frailty was associated with an increased rate of complications (surgical: OR, 2.91; 95% CI, 2.27-3.72; P < 0.0001; neurological: OR, 3.04; 95% CI, 2.43-3.81; P < 0.0001; major: OR, 2.75; 95% CI, 1.96-3.84; P < 0.0001), increased LOSs (incidence rate ratio, 3.08; 95% CI, 2.59-3.66; P < 0.0001), and an increased rate of nonroutine disposition (OR, 3.94; 95% CI, 2.91-5.34; P < 0.0001). CONCLUSIONS Frailty was associated with an increased likelihood of 30- and 90-day readmissions after elective treatment of UCAs. Frailty was notably associated with several postoperative complications, longer LOSs, and nonroutine disposition in the treatment of UCAs.
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Affiliation(s)
- Shivani D Rangwala
- Department of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jane S Han
- Department of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
| | - Krista Lamorie-Foote
- Department of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Li Ding
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Steven L Giannotta
- Department of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Frank J Attenello
- Department of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - William Mack
- Department of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Madrigal J, Tie EK, Verma A, Benharash P, Rapkin DA, St John MA. The Increasing Burden of Depression in Patients Undergoing Head and Neck Cancer Operations. Laryngoscope 2023; 133:3396-3402. [PMID: 37161918 DOI: 10.1002/lary.30735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/30/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Depression remains prevalent in patients undergoing head and neck cancer (HNCA) operations. The present study aimed to assess the impact of depression on perioperative and readmission outcomes following HNCA resection. METHODS All elective hospitalizations involving HNCA resection were identified from the 2010-2019 Nationwide Readmissions Database. Patients were stratified by history of depression. To perform risk-adjustment in assessing perioperative and readmission outcomes, 3:1 nearest neighbor matching was performed. A subpopulation analysis was also conducted to assess interval development of depression in the postoperative period. RESULTS Of an estimated 133,018 patients undergoing HNCA operations, 8.9% (n = 11,855) had comorbid depression. Over the decade-long study period, the prevalence of depression in this population increased (7.8% in 2010 vs. 10.0% in 2019, NPTrend<0.001). Among 24,938 propensity matched patients, those with depression had similar incidence of in-hospital mortality (0.4 vs. 0.7%, p = 0.14) as well as perioperative medical (22.0 vs. 21.9%, p = 0.93) and surgical (10.2 vs. 10.3, p = 0.84) complications, though had higher rates of non-home discharge (16.9 vs. 13.5%, p < 0.001) and 30-day readmission (13.6 vs. 11.8%, p = 0.030). Predictors of depression in the postoperative period included primary coverage by Medicare or Medicaid as well as comorbid anxiety or drug use disorder. CONCLUSION The prevalence of depression in HNCA patients continues to increase. Although depression was not associated with increased in-hospital mortality and complications, it did impact rates of rehospitalization as well as non-routine discharge. Screening and therapeutic interventions addressing such postoperative events may serve to improve long-term clinical and financial outcomes in this at-risk population. LEVEL OF EVIDENCE 3-Retrospective cohort study Laryngoscope, 133:3396-3402, 2023.
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Affiliation(s)
- Josef Madrigal
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Edward K Tie
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, California, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - David A Rapkin
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Raab GT, Restifo D, Tin AL, Vickers AJ, McBride SM, Wong RJ, Lee NY, Zakeri K, Shahrokni A. Differential use of postoperative psychosocial and physical services among older adults with head and neck cancer. J Geriatr Oncol 2023; 14:101609. [PMID: 37678051 DOI: 10.1016/j.jgo.2023.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/06/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Older adults undergoing head and neck cancer (HNC) surgery often have significant functional and mental health impairments. We examined use of postoperative physical, nutritional, and psychosocial services among a cohort of older adults with HNC comanaged by geriatricians and surgeons. MATERIALS AND METHODS Our sample consisted of older adults who were referred to the Geriatrics Service at Memorial Sloan Kettering Cancer Center between 2015 and 2019 and took a geriatric assessment (GA) prior to undergoing HNC surgery. Physical, nutritional, and psychosocial service utilization was assessed. Physical services included a physical, occupational, or rehabilitation consult during the patient's stay. Nutritional services consisted of speech and swallow or nutritional consult. Psychosocial services consisted of psychiatry, psychology, or a social work consult. Relationships between each service use, geriatric deficits, demographic, and surgical characteristics were assessed using Wilcoxon rank-sum test or Chi-square test. RESULTS In total, 157 patients were included, with median age of 80 and length of stay of six days. The most common GA impairments were major distress (61%), depression (59%), social activity limitation (SAL) (54%), and deficits in activities of daily living (ADL) (44%). Nutritional and physical services were used much more frequently than psychosocial services (80% and 85% vs 31%, respectively). Receipt of services was associated with longer median length of hospital stay, operation time, and greater deficits in ADLs. SAL was associated with physical and psychosocial consult and lower Timed Up and Go (TUG) score; instrumental ADL (iADL) deficits were associated with physical services; and depression and distress were associated with psychosocial services. DISCUSSION The burden of psychosocial deficits is high among older adults with HNC. Future work is needed to understand the limited utilization of psychosocial services in this population as well as whether referral to psychosocial services can reduce the burden of these deficits.
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Affiliation(s)
| | | | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean M McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Armin Shahrokni
- Geriatrics Service, Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA.
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Douse DM, Yin LX, Olawuni FO, Glasgow AE, Habermann EB, Price DL, Tasche KK, Moore EJ, Van Abel KM. Racial disparities in surgical treatment of oropharyngeal cancer: A Surveillance, Epidemiology, and End Results review. Head Neck 2023; 45:2313-2322. [PMID: 37461323 DOI: 10.1002/hed.27467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/03/2023] [Accepted: 07/09/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES Oropharyngeal squamous cell carcinoma (OPSCC) has been rising. This manuscript looks to explore racial disparities in the surgical management of OPSCC. METHODS A cancer database was queried for patients with OPSCC diagnosed from 2004 to 2017. Univariate and multivariable logistic regressions were used to evaluate associations between patient race/ethnicity, surgical treatment, and reasons for lack of surgery. RESULTS 37 306 (74.3%) patients did not undergo surgery, while 12 901 (25.7%) patients did. Non-Hispanic black (NHB) patients were less likely to undergo surgery than other races (17.9% vs. 26.5%; p < 0.0001). In clinical discussions, the Asian, Native American, Hawaiian, Pacific Islander (ANAHPI), and unknown race group was more likely to directly refuse surgery when recommended (2.5% vs. 1.5%; p = 0.015). CONCLUSION Racial differences exist in treatment for OPSCC. NHB patients are less likely to actually undergo surgical management for OPSCC, while other patients are more likely to directly "refuse" surgery outright when offered.
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Affiliation(s)
- Dontre' M Douse
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Felicia O Olawuni
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Glasgow
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall K Tasche
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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12
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Cheng T, Galicia K, Patel PP, Anstadt MJ, Gonzalez RP, Kubasiak J. A nationwide analysis of geriatric proximal humerus fractures: trends, outcomes, and cost. Trauma Surg Acute Care Open 2023; 8:e001055. [PMID: 37533777 PMCID: PMC10391795 DOI: 10.1136/tsaco-2022-001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/16/2023] [Indexed: 08/04/2023] Open
Abstract
Background In the USA, proximal humerus fractures (PHF) are the third most common fracture among the elderly. Although most geriatric PHF are treated conservatively, surgical management remains an option. This retrospective study compares annual trends, patient outcomes, and hospital costs between operatively and non-operatively managed geriatric PHF. Methods The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried from 2012 to 2015. Geriatric patients with PHF were identified and those who underwent operative or non-operative management were compared in trends, outcomes and costs. Results In total, 137 810 patients met inclusion criteria, of which 51 795 (37.6%) underwent operative management. The operative cohort was younger (76.6 vs 80.9, p<0.001) with a greater proportion of females (81.8% vs 77.6%, p<0.001). The operative cohort demonstrated less frailty and lower Elixhauser Comorbidity Scores (both p<0.001). The operative cohort was also more likely to be discharged home (30.4% vs 13.9%, p<0.001). There was no significant linear trend in age-adjusted and sex-adjusted proportions of operative versus non-operative geriatric PHF (p=0.071), but a positive linear trend was statistically significant for total cost of operative geriatric PHF (p<0.001). Multivariable analyses demonstrated similar overall complication rates between cohorts (OR 0.95, 95% CI 0.89 to 1.00; p=0.06), although surgical intervention increased length of stay (LOS) by 0.15 days (95% CI 0.03 to 0.27; p<0.001) and median cost of hospitalization by US$10 684 (95% CI US$10 384 to US$10 984; p<0.001). Conclusions This study identifies a positive linear trend in total cost of operatively managed geriatric PHF from 2012 to 2015. Operative management of geriatric PHF is associated with a similar overall complication rate and greater likelihood of being discharged home. Although non-operative management is associated with decreased LOS and hospital expenses, providers should consider surgical PHF treatment options when available and appropriate in the context of patient-focused outcomes, particularly long-term disposition after intervention. Level of Evidence This level IV retrospective study identifies.
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Affiliation(s)
- Teresa Cheng
- Department of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Kevin Galicia
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
- Burn and Shock Trauma Research Institute, Loyola University Medical Center, Maywood, Illinois, USA
| | - Purvi P Patel
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Michael J Anstadt
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Richard P Gonzalez
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
- Burn and Shock Trauma Research Institute, Loyola University Medical Center, Maywood, Illinois, USA
| | - John Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
- Burn and Shock Trauma Research Institute, Loyola University Medical Center, Maywood, Illinois, USA
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13
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Sakowitz S, Bakhtiyar SS, Verma A, Kronen E, Ali K, Chervu N, Benharash P. Risk and factors associated with venous thromboembolism following abdominal transplantation. Surg Open Sci 2023; 13:18-23. [PMID: 37091740 PMCID: PMC10119681 DOI: 10.1016/j.sopen.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 04/25/2023] Open
Abstract
Background Venous thromboembolism (VTE) remains under-studied among patients undergoing kidney, liver and pancreas (abdominal) transplantation. We characterized the risk and predictors of VTE using a nationally-representative cohort. Methods The 2014-2019 Nationwide Readmissions Database was queried to identify all adults undergoing abdominal transplantation. Patients who developed pulmonary embolism or deep venous thrombosis were considered the VTE cohort (others: nonVTE). Multivariable models were developed to identify factors linked with VTE and assess the independent associations between VTE and key outcomes. Results Of ~141,977 transplant recipients, 1.9 % (2722) developed VTE. The VTE cohort was similarly female (39.2 vs 38.0, p = 0.51), but more often demonstrated a higher Elixhauser comorbidity index (4.19 ± 1.40 vs 3.93 ± 1.39, p < 0.001).After adjustment, congestive heart failure (AOR 1.54, 95%CI 1.25-1.91), cardiac arrhythmias (AOR 1.54, 95%CI 1.34-1.78), peripheral vascular disease (AOR 1.29, 95%CI 1.02-1.63), coagulopathies (AOR 1.63, 95%CI 1.38-1.92), previous history of VTE (AOR 1.14, 95%CI 1.06-1.22), and heparin-induced thrombocytopenia (AOR 2.61, 95%CI 2.07-3.28) were associated with VTE. The development of VTE was linked with significantly greater in-hospital mortality (AOR 4.56, 95%CI 2.07-10.10), as well as infectious (AOR 2.59, 95%CI 1.55-4.21), cardiac (AOR 2.59, 95%CI 1.39-4.82), and respiratory (AOR 1.78, 95%CI 1.21-2.63) complications. VTE was further associated with increased length of stay (+8.18 days, 95%CI +1.32-15.41), expenditures (+$42,000, 95%CI $24,800-59,210), and odds of VTE upon readmission (AOR 4.51, 95%CI 1.32-15.41). Conclusions VTE after abdominal transplantation is linked with significantly greater in-hospital mortality, complications, resource utilization, and risk of VTE at readmission. Novel risk assessments and prophylaxis protocols are needed to reduce VTE incidence and sequelae.
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Affiliation(s)
- Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
- Department of Surgery, University of Colorado, Aurora, CO, United States of America
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Elsa Kronen
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, CA, United States of America
- Corresponding author at: UCLA Division of Cardiac Surgery, 64-249 Center for Health Sciences, Los Angeles, CA 90095, United States of America.
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14
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Matos LL, Sanabria A, Robbins KT, Halmos GB, Strojan P, Ng WT, Takes RP, Angelos P, Piazza C, de Bree R, Ronen O, Guntinas-Lichius O, Eisbruch A, Zafereo M, Mäkitie AA, Shaha AR, Coca-Pelaz A, Rinaldo A, Saba NF, Cohen O, Lopez F, Rodrigo JP, Silver CE, Strandberg TE, Kowalski LP, Ferlito A. Management of Older Patients with Head and Neck Cancer: A Comprehensive Review. Adv Ther 2023; 40:1957-1974. [PMID: 36920746 DOI: 10.1007/s12325-023-02460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/10/2023] [Indexed: 03/16/2023]
Abstract
The projected increase in life expectancy over the next few decades is expected to result in a rise in age-related diseases, including cancer. Head and neck cancer (HNC) is a worldwide health problem with high rates of morbidity and mortality. In this report, we have critically reviewed the literature reporting the management of older patients with HNC. Older adults are more prone to complications and toxicities secondary to HNC treatment, especially those patients who are frail or have comorbidities. Thus, this population should be screened prior to treatment for such predispositions to maximize medical management of comorbidities. Chronologic age itself is not a reason for choosing less intensive treatment for older HNC patients. Whenever possible, also older patients should be treated according to the best standard of care, as nonstandard approaches may result in increased treatment failure rates and mortality. The treatment plan is best established by a multidisciplinary tumor board with shared decision-making with patients and family. Treatment modifications should be considered for those patients who have severe comorbidities, evidence of frailty (low performance status), or low performance status or those who refuse the recommendations of the tumor board.
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Affiliation(s)
- Leandro L Matos
- Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (ICESP), University of São Paulo Medical School, and Faculdade Israelita de Ciências da Saúde Albert Einstein Medical School, São Paulo, Brazil
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - K Thomas Robbins
- Division of Otolaryngology, Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Gyorgy B Halmos
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Wai Tong Ng
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Robert P Takes
- Department of Otolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Cesare Piazza
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ohad Ronen
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andres Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Israel, Affiliated with Ben-Gurion University of the Negev, Sheva, Israel
| | - Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Otolaryngology, Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Timo E Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life-Course Health Research, University of Oulu, Oulu, Finland
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, 8th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil.
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil.
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Malnutrition risk and frailty in head and neck cancer patients: coexistent but distinct conditions. Eur Arch Otorhinolaryngol 2023; 280:1893-1902. [PMID: 36484854 PMCID: PMC9988738 DOI: 10.1007/s00405-022-07728-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Both malnutrition and frailty are associated with adverse treatment outcomes. Malnutrition (risk) and frailty are each commonly present in patients with head and neck cancer (HNC). However, their coexistence and association is unknown. Main goal of this study is to determine the coexistence of, and the association between malnutrition risk and frailty in patients with HNC. METHODS In this retrospective analysis on prospectively collected data, newly diagnosed patients with HNC, enrolled in the OncoLifeS databiobank were included. The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) was used to assess malnutrition risk. The Groningen Frailty Indicator (GFI) was used to assess frailty status. Multivariate logistic regression analyses were performed, taking into account several patient- and tumor-related factors. RESULTS In total, 197 patients were included. Seventy-six patients (39%) had a medium or high malnutrition risk and 71 patients (36%) were frail. In 38 patients (19%), malnutrition risk coexisted with frailty. Patients with medium and high malnutrition risk were, respectively, 4.0 (95% CI 1.5-11.2) and 13.4 (95% CI 4.0-48.7) times more likely to be frail, compared to patients with low malnutrition risk. In turn, frail patients were 6.4 times (95% CI 2.6-14.9) more likely to have malnutrition risk compared to non-frail patients. CONCLUSIONS Malnutrition risk and frailty frequently coexist but not fully overlap in newly diagnosed patients with HNC. Therefore, screening for both conditions is recommended.
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Pruitt SL, Tavakkoli A, Zhu H, Heitjan DF, Gerber DE, Singal AG, Halm EA, Beg MS, Maddineni B, Kansagra AJ, Murphy CC. Survival of cancer survivors with a new pancreatic cancer diagnosis. Cancer Med 2023; 12:200-212. [PMID: 35674139 PMCID: PMC9844592 DOI: 10.1002/cam4.4903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Persons newly diagnosed with pancreas cancer and who have survived a previous cancer are often excluded from clinical trials, despite limited evidence about their prognosis. We examined the association between previous cancer and overall survival. METHODS This US population-based cohort study included older adults (aged ≥66 years) diagnosed with pancreas cancer between 2005 and 2015 in the linked Surveillance, Epidemiology, and End Results-Medicare data. We used Cox proportional hazards models to estimate stage-specific effects of previous cancer on overall survival, adjusting for sociodemographic, treatment, and tumor characteristics. RESULTS Of 32,783 patients, 18.7% were previously diagnosed with another cancer. The most common previous cancers included prostate (29.0%), breast (18.9%), or colorectal (9.7%) cancer. More than half of previous cancers (53.9%) were diagnosed 5 or more years prior to pancreas cancer diagnosis or at an in situ or localized stage (47.8%). The proportions of patients surviving 1, 3, and 5 years after pancreas cancer were nearly identical for those with and without previous cancer. Median survival in months was as follows for those with and without previous cancer respectively: 7 versus 8 (Stage 0/I), 10 versus 10 (Stage II), 7 versus 7 (Stage III), and 3 versus 2 (Stage IV). Cox models indicated that patients with previous cancer had very similar or statistically equivalent survival to those with no previous cancer. CONCLUSIONS Given nearly equivalent survival compared to those without previous cancer, cancer survivors newly diagnosed with pancreas cancer should be considered for inclusion in pancreas cancer clinical trials.
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Affiliation(s)
- Sandi L. Pruitt
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
| | - Anna Tavakkoli
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Hong Zhu
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
| | - Daniel F. Heitjan
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Statistical ScienceSouthern Methodist UniversityDallasTexasUSA
| | - David E. Gerber
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Amit G. Singal
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ethan A. Halm
- Rutgers Biological Health Sciences (RBHS)Rutgers UniversityNew BrunswickNew JerseyUSA
- Robert Wood Johnson Medical SchoolDepartment of MedicineNew BrunswickNew JerseyUSA
| | | | - Bhumika Maddineni
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ankit J. Kansagra
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Caitlin C. Murphy
- School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTexasUSA
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17
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Henry RK, Uppuluri A, Zarbin MA, Bhagat N. The Impact of Frailty Syndrome on Endogenous Endophthalmitis Development and Outcomes: A Population-Level Analysis. Ophthalmology 2022; 129:1440-1447. [PMID: 35843372 DOI: 10.1016/j.ophtha.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Characterize the impact of frailty on endogenous endophthalmitis (EE) development and clinical outcomes among septicemic patients. DESIGN Population-level, retrospective cohort study. PARTICIPANTS Adult inpatients within the National Inpatient Sample (years 2002-2014) diagnosed with bacterial septicemia. METHODS Septicemic patients were classified as frail or nonfrail using the previously validated Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator, and diagnosis of EE was abstracted from International Classification of Diseases 9 codes. We used multivariable logistic regression to generate odds ratios (ORs) for rates of EE development and in-hospital mortality based on frailty status. We also examined the association between frailty and blood culture-proven organism class, inpatient length of stay, and total charges billed to insurance. MAIN OUTCOME MEASURES Incidence of EE among septicemic patients; rates of EE development among frail and nonfrail patients; blood culture-proven microbe type, length of stay, and total charges billed to insurance. RESULTS 9294 of 18 470 658 (0.05%) inpatients with bacteremia developed EE, 2102 (22.6%) of whom had at least 1 frailty-defining feature (predominantly malnutrition [68%]). Odds of developing EE were 16.7% higher for frail patients (OR, 1.167; 95% confidence interval, 1.108-1.229) when controlling for age, sex, race, concomitant human immunodeficiency virus/AIDS, pyogenic liver abscess, infectious endocarditis, cirrhosis, and diabetes with chronic complications. Frail EE patients had a 27.9% increased odds of in-hospital death, independent of age, sex, race, and Elixhauser comorbidity score (OR, 1.279; 95% confidence interval, 1.056-1.549). Higher rates of methicillin-resistant Staphylococcus aureus bacteremia (14.3% vs. 10.9%, P = 0.000016), gram-negative bacteremia (7.6% vs. 4.9%, P = 0.000003), and concomitant candidemia (10.4% vs. 7.0%, P = 0.0000004) were associated with frailty. Hospital stays were significantly longer (median, 14 days; interquartile range, 19 days; P < 0.00001) and total charges billed to insurance were significantly greater (median, $96 398; interquartile range, $154,682; P < 0.00001) among frail EE patients. CONCLUSIONS Frailty syndrome is independently associated with development of EE in the setting of bacterial septicemia; frailty-associated EE may occur in patients with malnutrition and particular bacterial subtypes, and it predisposes to higher rates of in-hospital death and health care resource usage.
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Affiliation(s)
- Roger K Henry
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Aditya Uppuluri
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marco A Zarbin
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
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Ebrahimian S, Lee C, Tran Z, Sakowitz S, Bakhtiyar SS, Verma A, Tillou A, Benharash P, Lee H. Association of frailty with outcomes of resection for colonic volvulus: A national analysis. PLoS One 2022; 17:e0276917. [PMID: 36346811 PMCID: PMC9642887 DOI: 10.1371/journal.pone.0276917] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background With limited national studies available, we characterized the association of frailty with outcomes of surgical resection for colonic volvulus. Methods Adults with sigmoid or cecal volvulus undergoing non-elective colectomy were identified in the 2010–2019 Nationwide Readmissions Database. Frailty was identified using the Johns Hopkins indicator which utilizes administrative codes. Multivariable models were developed to examine the association of frailty with in-hospital mortality, perioperative complications, stoma use, length of stay, hospitalization costs, non-home discharge, and 30-day non-elective readmissions. Results An estimated 66,767 patients underwent resection for colonic volvulus (Sigmoid: 39.6%; Cecal: 60.4%). Using the Johns Hopkins indicator, 30.3% of patients with sigmoid volvulus and 15.9% of those with cecal volvulus were considered frail. After adjustment, frail patients had higher risk of mortality compared to non-frail in both sigmoid (10.6% [95% CI 9.47–11.7] vs 5.7% [95% CI 5.2–6.2]) and cecal (10.4% [95% CI 9.2–11.6] vs 3.5% [95% CI 3.2–3.8]) volvulus cohorts. Frailty was associated with greater odds of acute venous thromboembolism occurrences (Sigmoid: AOR 1.50 [95% CI 1.18–1.94]; Cecal: AOR 2.0 [95% CI 1.50–2.72]), colostomy formation (Sigmoid: AOR 1.73 [95% CI 1.57–1.91]; Cecal: AOR 1.48 [95% CI 1.10–2.00]), non-home discharge (Sigmoid: AOR 1.97 [95% CI 1.77–2.20]; Cecal: AOR 2.56 [95% CI 2.27–2.89]), and 30-day readmission (Sigmoid: AOR 1.15 [95% CI 1.01–1.30]; Cecal: AOR 1.26 [95% CI 1.10–1.45]). Frailty was associated with incremental increase in length of stay (Sigmoid: +3.4 days [95% CI 2.8–3.9]; Cecal: +3.8 days [95% CI 3.3–4.4]) and costs (Sigmoid: +$7.5k [95% CI 5.9–9.1]; Cecal: +$12.1k [95% CI 10.1–14.1]). Conclusion Frailty, measured using a simplified administrative tool, is associated with significantly worse clinical and financial outcomes following non-elective resections for colonic volvulus. Standard assessment of frailty may aid risk-stratification, better inform shared-decision making, and guide healthcare teams in targeted resource allocation in this vulnerable patient population.
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Affiliation(s)
- Shayan Ebrahimian
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Cory Lee
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States of America
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, University of Colorado, Aurora, CO, United States of America
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Areti Tillou
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Hanjoo Lee
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, United States of America
- * E-mail:
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19
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Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures? J Craniofac Surg 2022; 33:2573-2577. [DOI: 10.1097/scs.0000000000008825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022] Open
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20
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Shah HP, Cohen O, Sukys J, Dibble J, Mehra S. The impact of frailty on adjuvant treatment in patients with head and neck free flap reconstruction-A retrospective study using two independent frailty scores. Oral Oncol 2022; 132:106006. [PMID: 35835056 DOI: 10.1016/j.oraloncology.2022.106006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Reconstructive surgery may result in prolonged postoperative recovery, especially in frail patients, which in turn may impact delivery of adjuvant therapy. To date, no studies have investigated potential associations between frailty and adjuvant treatment delivery after reconstructive surgery. We examine the impact of frailty on time to initiation, duration, and completion of adjuvant treatment after reconstructive surgery for head and neck cancers (HNCs). METHODS A retrospective review of patients who underwent free flap reconstruction for HNC at a single institution from 2015 to 2021 and received adjuvant radiation was performed. Frailty was assessed using two independent scales: the 11-item modified frailty index (mFI) score and binary Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator. Timely adjuvant initiation (within six weeks of surgery), duration of adjuvant treatment, and completion were compared between frail and non-frail patients. RESULTS Of the 163 patients included for analysis, 52 (31.9%) were identified as frail by the ACG indicator and 24 (14.7%) were identified as frail with an mFI score ≥ 3. Frail patients (mFI score ≥ 3) were significantly less likely than non-frail patients to initiate adjuvant treatment within six weeks (OR:0.21, CI:0.04-0.85, p = 0.046). Frailty designated by either frailty scale was not significantly associated with adjuvant treatment duration. Likelihood of adjuvant treatment completion was significantly lower for frail compared to non-frail patients by both scales: ACG indicator (OR 0.02, CI:9.05 × 10-4-0.25, p = 0.007) and mFI score ≥ 3 (OR:0.01, CI:6.85 × 10-4-0.13, p = 0.007). CONCLUSIONS Frailty is associated with decreased likelihood of timely adjuvant treatment initiation and completion in patients with HNCs after free flap reconstruction.
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Affiliation(s)
- Hemali P Shah
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Oded Cohen
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Jordan Sukys
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Jacqueline Dibble
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Saral Mehra
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA.
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21
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Voora RS, Qian AS, Kotha NV, Qiao EM, Meineke M, Murphy JD, Orosco RK. Frailty Index as a Predictor of Readmission in Patients With Head and Neck Cancer. Otolaryngol Head Neck Surg 2022; 167:89-96. [PMID: 34520305 DOI: 10.1177/01945998211043489] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the predictive utility of the Hospital Frailty Risk Score (HFRS), a stratification tool based on the ICD-10 (International Classification of Disease, Tenth Revision), and other risk factors for 30-day readmissions and mortality in a nationally representative cohort. STUDY DESIGN Retrospective database review. SETTING Nationwide Readmissions Database (2017). METHODS Patients with head and neck cancer who underwent major surgical procedures were identified from the 2017 Nationwide Readmissions Database, representing 116 medical centers nationwide. Bivariate and multivariable logistic regression methods were used to identify factors associated with unplanned 30-day readmission, 30-day readmission mortality, and increased length of hospital stay. RESULTS A total of 14,420 patients underwent major head and neck cancer surgery. Unplanned readmission occurred in 11% of patients. The most common reasons for unplanned readmission were procedural complications (26.5%), sepsis (7.3%), and respiratory failure (3.9%). Elevated frailty index (HFRS ≥5) was identified in 22% of patients. Frailty was associated with higher 30-day readmission rates (18.0% vs 9.5%, P < .01), which held on multivariate modeling (odds ratio [OR], 1.59 [95% CI, 1.37-1.85]). Frail patients spent more days in the hospital (8.2 vs 6.8, P = .02) and incurred more charges across hospital stays ($275,000 vs $188,000, P < .01). Patients >75 years old (OR, 1.26 [1.03-1.55]) and patients with electrolyte abnormalities (OR, 1.25 [1.07-1.46] were significantly more likely to be readmitted. CONCLUSION In this head and neck cancer surgical population, HFRS significantly predicted unplanned readmission. HFRS is a potential risk stratification tool and should be compared with other methods and explored in other cancer populations. Beyond the challenge of identifying at-risk patients, future work should explore potential interventions aimed at mitigating readmission.
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Affiliation(s)
- Rohith S Voora
- School of Medicine, University of California-San Diego, San Diego, California, USA.,Division of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, USA
| | - Alexander S Qian
- School of Medicine, University of California-San Diego, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California-San Diego, La Jolla, California, USA
| | - Nikhil V Kotha
- School of Medicine, University of California-San Diego, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California-San Diego, La Jolla, California, USA
| | - Edmund M Qiao
- School of Medicine, University of California-San Diego, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California-San Diego, La Jolla, California, USA
| | - Minhthy Meineke
- Department of Anesthesiology, School of Medicine, University of California-San Diego, La Jolla, California, USA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California-San Diego, La Jolla, California, USA.,Moores Cancer Center, La Jolla, California, USA
| | - Ryan K Orosco
- Division of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA
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22
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Rubens M, Cristian A, Ramamoorthy V, Saxena A, McGranaghan P, Tonse R, Veledar E. Effect of frailty on hospital outcomes among patients with cancer in the United States: Results from the National Inpatient Sample. J Geriatr Oncol 2022; 13:1043-1049. [PMID: 35752604 DOI: 10.1016/j.jgo.2022.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/12/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION To understand the effects of frailty on hospital outcomes such as in-hospital mortality, length of stay, and healthcare cost among patients with cancer using a nationally representative database. MATERIALS AND METHODS This study was a retrospective observational analysis of Nationwide Inpatient Sample (NIS) data collected during 2005-2014. Participants included adult patients with cancer ≥45 years identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. 'Frail' versus 'non-frail' hospitalizations were determined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnosis indicator. Main outcome measures were in-hospital mortality, hospital length of stay, and hospitalization cost. We defined prolonged length of stay as hospital stay ≥75th percentile of the study sample. Propensity score match analysis was done to examine whether frailty was associated with length of stay and in-hospital mortality. RESULTS There were 10,463,083 cancer hospitalizations during 2005-2014, of which 1,022,777 (9.8%) were frail. Patients having length of stay ≥8 days were significantly higher among frail group, compared to non-frail group (53.3% versus 25.3%, P < 0.001). Similarly, unadjusted mortality (12.0% versus 5.3%, P < 0.001) and hospitalization costs ($29,726 versus $18,595, P < 0.001) were significantly higher for frail patients. Nearly $28 billion was expended on hospitalization of frail patients with cancer during the study period. In propensity score match analysis, the odds of in-hospital mortality (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.50-1.58) and length of stay (OR, 2.23; 95% CI, 2.18-2.27) were significantly greater for frail patients. DISCUSSION Frailty was associated with adverse hospital outcomes such as increased length of stay, mortality, and hospitalization cost among all cancer types. Our findings could be valuable for frailty-based risk stratification of patients with cancer. Concerted efforts by the physiatrists, oncologists, and surgeons towards identifying frailty and incorporating it in risk estimation measures could help in optimizing management strategies for cancer.
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23
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Cleere EF, Davey MG, O'Neill JP. "Age is just a number"; frailty as a marker of peri-operative risk in head and neck surgery: Systematic review and meta-analysis. Head Neck 2022; 44:1927-1939. [PMID: 35653114 DOI: 10.1002/hed.27110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Frailty refers to a patient's reduced capacity to withstand stressors due to a reduction in physiologic reserves. We assessed the impact of frailty on outcomes following head and neck surgery. METHODS We performed a systematic review in accordance with the PRISMA guidelines. Meta-analysis was performed using the Mantel-Haenszel method. RESULTS Fourteen studies incorporating 182 059 patients were included in qualitative synthesis with 15 953 (8.8%) of patients deemed as frail. Meta-analysis incorporating nine studies demonstrated that frailty is associated with an increased 30 day postoperative morbidity (OR 2.74; 95% CI 1.98-3.80; p < 0.01) and meta-analysis with six studies suggested increased 30-day mortality (OR 2.94; 95% CI 2.62-3.31; p < 0.01). Preliminary meta-analyses between two and five studies suggested that frail patients had reduced overall survival and were more likely to be discharged to a nonhome location or readmitted within 30 days. CONCLUSIONS Frailty appears to be associated with poor short-term outcomes following head and neck surgery and may improve understanding of an individual patient's peri-operative risk.
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Affiliation(s)
- Eoin F Cleere
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Matthew G Davey
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - James P O'Neill
- Department of Otolaryngology - Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland.,The Royal College of Surgeons in Ireland, Dublin, Ireland
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Martinez C, Atwez A, Durkin M, Averch T, Mujadzic M, Friedman HI, Gilstrap J. The Utility of the 5-Factor Modified Frailty Index to Predict Postoperative Risk in Microsurgical Reconstruction. Ann Plast Surg 2022; 88:S485-S489. [PMID: 35690943 DOI: 10.1097/sap.0000000000003125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Microsurgical reconstruction is an integral part of plastic surgery. The 5-factor modified frailty index (5-mFI) is an effective tool to predict postoperative complications across multiple subspecialties. We aimed to determine if frailty scores using the 5-mFI can predict postoperative complications specifically in microvascular reconstruction. STUDY DESIGN Frailty scores were retrospectively assessed in microsurgical reconstruction patients (2012-2016) using the American College of Surgeons National Quality Improvement Program base. The 5 variables that comprise the 5-mFI are history of chronic obstructive pulmonary disease, history of congestive heart failure, functional status, hypertension requiring medication and diabetes. The data were analyzed using the Goodman test, χ2 test, and a logistic regression model. The congruence was also compared between the 5-mFI and the American Society of Anesthesiology (ASA) classification in predicting complications. RESULTS Of 5894 patients, the highest 5-mFI value was "3." Analyses show an increase in postoperative complications requiring ICU care. Further models indicate an association between readmission with hypertension and chronic obstructive pulmonary disease (P < 0.05). There was an increased risk of a failure to wean from ventilator with a history of chronic obstructive pulmonary disease and diabetes and an increased risk of readmission with a history of hypertension and chronic obstructive pulmonary disease. The 5-mFI and ASA were incongruent in predicting postoperative complications. CONCLUSIONS The 5-mFI predicts postoperative complications in the microsurgical reconstruction population. Although the 5-mFI and ASA predict different complications, their use provides insight into the potential adjustable risks before surgery.
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Affiliation(s)
- Carlos Martinez
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia
| | - Abdelaziz Atwez
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia
| | - Martin Durkin
- Department of Biostatistics and Research, Prisma Health, Greenville
| | - Timothy Averch
- Division of Urology, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia, SC
| | - Mirsad Mujadzic
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia
| | - Harold I Friedman
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia
| | - Jarom Gilstrap
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia
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Guo Y, Wu H, Sun W, Hu X, Dai J. Effects of frailty on postoperative clinical outcomes of aneurysmal subarachnoid hemorrhage: results from the National Inpatient Sample database. BMC Geriatr 2022; 22:460. [PMID: 35624415 PMCID: PMC9145390 DOI: 10.1186/s12877-022-03141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to investigate the potential effect of preoperative frailty on postoperative clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods Data of patients aged 18 years and older who were diagnosed with subarachnoid hemorrhage or intracerebral hemorrhage, underwent aneurysm repair surgical intervention from 2005 to 2014. A retrospective database analysis was performed based on U.S. National Inpatient Sample (NIS) from 2005 to 2014. Frailty was determined using the Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator. Patients were stratified into frail and non-frail groups and the study endpoints were incidence of postoperative complications and related adverse clinical outcomes. Results Among 20,527 included aSAH patients, 2303 (11.2%) were frail and 18,224 (88.8%) were non-frail. Significant differences were found between frailty and non-frailty groups in the four clinical outcomes (all p < 0.05). Multivariate analysis showed that frailty was associated with significant higher risks of discharge to institutional care (aOR: 2.50, 95%CI: 2.10–2.97), tracheostomy or gastrostomy tube replacement (aOR: 4.41, 95%CI: 3.81–5.10) and postoperative complications (aOR: 3.29, 95%CI: 2.55–4.25) but a lower risk of death in hospital (aOR: 0.40, 95%CI: 0.33–0.49) as compared with non-frailty. Stratified analysis showed the impact of frailty on some of the outcomes were greater among patients younger than 65 years than their older counterparts. Conclusions Frailty is significantly correlated with the increased risk of discharge to institutional care, tracheostomy or gastrostomy tube placement, and postoperative complications but with the reduced risk of in-hospital mortality outcomes after aneurysm repair. Frailty seems to have greater impact among younger adults than older ones. Baseline frailty evaluation could be applied to risk stratification for aSAH patients who were undergoing surgery.
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Affiliation(s)
- Yubin Guo
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, China.,Cerebrovascular Disease Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.2000 Jiangyue Road, Shanghai, 201112, China
| | - Hui Wu
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, China.,Cerebrovascular Disease Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.2000 Jiangyue Road, Shanghai, 201112, China
| | - Wenhua Sun
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, China.,Cerebrovascular Disease Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.2000 Jiangyue Road, Shanghai, 201112, China
| | - Xiang Hu
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, China.,Cerebrovascular Disease Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.2000 Jiangyue Road, Shanghai, 201112, China
| | - Jiong Dai
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.1630 Dongfang Road, Shanghai, 200127, China. .,Cerebrovascular Disease Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, No.2000 Jiangyue Road, Shanghai, 201112, China.
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Park MG, Haro G, Mabeza RM, Sakowitz S, Verma A, Lee C, Williamson C, Benharash P. Association of Frailty with clinical and financial outcomes of Esophagectomy hospitalizations in the US. Surg Open Sci 2022; 9:80-85. [PMID: 35719414 PMCID: PMC9198451 DOI: 10.1016/j.sopen.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/28/2022] [Accepted: 05/14/2022] [Indexed: 11/11/2022] Open
Abstract
Background Frailty, defined as impaired physiologic reserve and function, has been associated with inferior results after surgery. Using a coding-based tool, we examined the clinical and financial impact of frailty on outcomes following esophagectomy. Methods Adults undergoing elective esophagectomy were identified using the 2010–2018 Nationwide Readmissions Database. Using the binary Johns Hopkins Adjusted Clinical Groups frailty indicator, patients were classified as frail or nonfrail. Multivariable regression models were used to evaluate the association of frailty with in-hospital mortality, complications, hospitalization duration, costs, nonhome discharge, and unplanned 30-day readmission. Results Of 45,361 patients who underwent esophagectomy, 18.7% were considered frail. Most frail patients were found to have diagnoses of malnutrition (70%) or weight loss (15%) at the time of surgery. After adjustment, frailty was associated with increased risk of in-hospital mortality (adjusted odds ratio 1.67, 95% confidence interval 1.29–2.16) and overall complications (adjusted odds ratio 1.57, 95% confidence interval 1.44–1.71). Frailty conferred a 5.6-day increment in length of stay (95% confidence interval 4.94–6.45) and an additional $19,900 hospitalization cost (95% confidence interval $16,700–$23,100). Frail patients had increased odds of nonhome discharge (adjusted odds ratio 1.53, 95% confidence interval 1.35–1.75) as well as unplanned 30-day readmissions (adjusted odds ratio 1.17, 95% confidence interval 1.02–1.34). Conclusion Frailty, as detected by an administrative tool, is associated with worse clinical and financial outcomes following esophagectomy. The inclusion of standardized assessment of frailty in risk models may better inform patient selection and shared decision-making prior to operative intervention.
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Lia Q, Li K, Yang Q, Lian Y, Zhao M, Shi Z, Wang J, Zhang Y. Influence of frailty and its interaction with comorbidity on outcomes among total joint replacement. BMC Musculoskelet Disord 2022; 23:384. [PMID: 35468790 PMCID: PMC9040243 DOI: 10.1186/s12891-022-05333-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/13/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients with frailty get more and more attention in clinical practice. Yet, no large-scale studies have explored the impact of frailty on the perioperative acute medical and surgical complications following TJA. what is more, comorbid diseases may lead, at least additively, to the development of frailty. There also no studies to find the possible interaction between comorbidity and frailty on the postoperative complications after TJA. METHODS Discharge data of 2,029,843 patients who underwent TJA from 2005 to 2014 from the National Inpatient Sample (NIS) database, which was analyzed using cross-tabulations and multivariate regression modeling. Frailty was defined based on frailty-defining diagnosis clusters from frailty-defining diagnosis indicator of Johns Hopkins Adjusted Clinical Groups. RESULTS Among patients who underwent total joint replacement surgeries, 50,385 (2.5%) were identified as frail. Frailty is highly associated with old age, especially for those over the age of 80, meanwhile females and black races have a high Charlson comorbidity index (CCI) of ≥ 3, together with emergency/urgent admission and teaching hospital. While comorbidity is associated with greater odds of acute medical complications, and frailty has a better predictive effect on in-hospital deaths, acute surgical complications. Furthermore, frailty did not show an enhancement in the predictive power of the Charlson comorbidity score for postoperative complications or in-hospital deaths but postoperative LOS and hospitalization costs. CONCLUSION Frailty can be used to independently predicted postoperative surgical and medical complications, which also has a synergistic interaction with comorbidity for patients who are preparing to undergo TJA.
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Affiliation(s)
- Qiang Lia
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Kangxian Li
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Yun Lian
- First Affiliation Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Mingchen Zhao
- School of Public Health, Peking University, Beijing, China
| | - Zhanjun Shi
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Yang Zhang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
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Association of Frailty with Perioperative Outcomes Following Hepatic Resection: A National Study. J Am Med Dir Assoc 2022; 23:684-689.e1. [PMID: 35304129 DOI: 10.1016/j.jamda.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Risk of mortality and major comorbidity remains high following hepatic resection. Given recent advancements in nonsurgical techniques to control hepatic malignancy, accurate assessment of surgical candidates, especially those considered frail, has become imperative. The present study aimed to characterize the impact of frailty on clinical and financial outcomes following hepatic resection in older individuals. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS All older adults (≥65 years) undergoing elective hepatic resection were identified from the 2012 to 2019 National Inpatient Sample. METHODS Frailty was defined by using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Multivariable regression models were developed to assess the independent association of frailty with mortality, perioperative complications, and resource utilization. Marginal effects were tabulated to assess the impact of hospital volume on frailty-associated mortality. RESULTS Of an estimated 40,735 patients undergoing major hepatic resection, 9.0% were considered frail. After multivariable adjustment, frailty was associated with increased odds of mortality (adjusted odds ratio [AOR] 2.9; 95% confidence interval [CI] 2.0-4.3; P < .001) and perioperative complication (AOR 2.9; 95% CI 2.4-3.4; P < .001). Furthermore, frail patients incurred longer risk-adjusted length of stay (14.2 vs 6.7 days, P < .001) and greater hospitalization costs ($55,100 vs $29,300, P < .001). In assessing the impact of institutional expertise on perioperative outcomes, the marginal effect of frailty on mortality became less pronounced with increasing operative volume. CONCLUSIONS AND IMPLICATIONS As the population of the United States continues to age, surgeons are increasingly likely to encounter candidates for major hepatic resection who are frail. The present study associated frailty with inferior clinical and financial outcomes; however, frailty-associated mortality became less pronounced at centers with high hepatic resection operative volume. Coding-based instruments, such as the Johns Hopkins Adjusted Clinical Groups, may identify patients from electronic medical records who may benefit from further geriatric assessment and targeted treatments.
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Mady LJ, Baddour K, Hodges JC, Magaña LC, Schwarzbach HL, Borrebach JD, Nilsen ML, Johnson JT, Hall DE. The impact of frailty on mortality in non-surgical head and neck cancer treatment: Shifting the clinical paradigm. Oral Oncol 2022; 126:105766. [PMID: 35168191 PMCID: PMC9642850 DOI: 10.1016/j.oraloncology.2022.105766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/11/2022] [Accepted: 02/06/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Compare survival of head and neck cancer (HNC) patients treated with surgical or non-surgical management according to frailty, quantify frailty with the Risk Analysis Index (RAI), a validated 14-item instrument. MATERIALS AND METHODS Prospective cohort study of newly diagnosed HNC patients (≥18 years) who had frailty assessment from April 13, 2016 to September 30, 2016. Primary outcome was overall survival at 1- and 3-years. Cox proportional hazard models were utilized to examine mortality with predictor variables. Adjusted and unadjusted (Kaplan-Meier) survival curves stratified by either RAI scores or treatment modality were plotted. Kruskal-Wallis and likelihood ratio chi-square tests were used for comparing clinicodemographic variables. RESULTS Of 165 patients, 54 (32.7%) were managed non-surgically, 49 (29.7%) were treated with definitive surgery only, and 62 (37.6%) were treated with multimodality (surgery + adjuvant) therapy. Among the full cohort and subgroup analysis of the frail/very frail (RAI ≥ 37), non-surgical patients had worse or similar 3-year survival than those treated with surgery +/- adjuvant therapy. Multivariable Cox proportional hazard models demonstrate that frail patients treated non-surgically experienced worse survival than their counterparts treated with surgery (HR = 2.50, p = 0.015, 95% CI: 1.19, 5.23) or multimodality therapy (HR = 3.91, p < 0.001, 95% CI: 1.94-7.89). CONCLUSION Across all levels of frailty, long term survival of HNC patients treated without surgery is either worse than or like those treated with surgery. These findings (1) challenge current practices of steering patients "too frail for surgery" towards non-surgical, "non-invasive" therapy, and (2) suggest equipoise warranting randomized trials to clarify treatment of frail patients.
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Affiliation(s)
- Leila J. Mady
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Khalil Baddour
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Linda C. Magaña
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hannah L. Schwarzbach
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Marci L. Nilsen
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jonas T. Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel E. Hall
- Wolff Center at UPMC, Pittsburgh, PA, USA,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA,Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA,Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Han SH, Cho D, Mohammad R, Jung YH, Ahn SH, Cha W, Jeong WJ. Use of the comprehensive geriatric assessment for the prediction of postoperative complications in elderly patients with head and neck cancer. Head Neck 2021; 44:672-680. [PMID: 34918845 DOI: 10.1002/hed.26958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To determine the efficacy of preoperative Comprehensive Geriatric Assessment (CGA) in predicting postoperative complications in elderly patients undergoing head and neck cancer surgery. METHODS Medical records of patients aged ≥70 who underwent elective head and neck cancer surgery were reviewed. CGA scores were prospectively collected prior to surgery and analyzed to determine their association with postoperative complications. RESULTS Of the 65 patients enrolled in this study, 34 (52.3%) with deficits in two or more preoperative CGA domains were categorized as "frail." Fourteen patients (21.5%) experienced postoperative complications. Age was not a risk factor for the complications (p = 0.504). The multivariate analysis indicated that major postoperative complications were significantly associated with frailty (odds ratio [OR] = 21.9, p = 0.039), operation time (OR = 39, p = 0.048), and estimated blood loss (OR = 19.8, p = 0.043). CONCLUSIONS Frailty assessed by preoperative CGA, but not chronological age, was significantly associated with major postoperative complications in elderly patients undergoing head and neck cancer surgery.
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Affiliation(s)
- Seung Hoon Han
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Deuktae Cho
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ramla Mohammad
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.,Department of Otolaryngology - Head & Neck Surgery, Jaber Al-Ahmad Hospital, Ministry of Health, South Surra, Kuwait
| | - Young Ho Jung
- Department of Otorhinolaryngology - Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology - Head & Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis. PLoS One 2021; 16:e0259863. [PMID: 34793514 PMCID: PMC8601523 DOI: 10.1371/journal.pone.0259863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background Treatment options for mitral regurgitation range from diuretic therapy, to surgical and interventional strategies including TMVR in high-risk surgical candidates. Frailty has been associated with inferior outcomes following hospitalizations for heart failure and in open cardiac surgery. Objective The purpose of the present study was to evaluate the impact of frailty on clinical outcomes and resource use following transcatheter mitral valve repair (TMVR). Methods Adults undergoing TMVR were identified using the 2016–2018 Nationwide Readmissions Database, and divided into Frail and Non-Frail groups. Frailty was defined using a derivative of the Johns Hopkins Adjusted Clinical Groups frailty indicator. Generalized linear models were used to assess the association of frailty with in-hospital mortality, complications, nonhome discharge, hospitalization costs, length of stay, and non-elective readmission at 90 days. Average marginal effects were used to quantify the impact of frailty on predicted mortality. Results Of 18,791 patients undergoing TMVR, 11.6% were considered frail. The observed mortality rate for the overall cohort was 2.2%. After adjustment, frailty was associated with increased odds of in-hospital mortality (AOR 1.8, 95% CI 1.2–2.6), corresponding to an absolute increase in risk of mortality of 1.1%. Frailty was associated with a 2.7-day (95% CI 2.1–3.2) increase in postoperative LOS, and $18,300 (95% CI 14,400–22,200) increment in hospitalization costs. Frail patients had greater odds (4.4, 95% CI 3.6–5.4) of nonhome discharge but similar odds of non-elective 90-day readmission. Conclusions Frailty is independently associated with inferior short-term clinical outcomes and greater resource use following TMVR. Inclusion of frailty into existing risk models may better inform choice of therapy and shared decision-making.
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Lee CC, Hunter WP, Hajibandeh JT, Peacock ZS. Does the Modified Frailty Index (mFI-5) Predict Adverse Outcomes in Maxillofacial Fracture Repair? J Oral Maxillofac Surg 2021; 80:472-480. [PMID: 34732361 DOI: 10.1016/j.joms.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Frailty has been recognized as a predictor of postoperative adverse outcomes in many surgical subspecialties. The purpose of this study was to evaluate the relationship between frailty and complications in patients undergoing operative repair of facial fractures. METHODS The authors utilized the 2011 to 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases to identify patients with facial fractures undergoing operative repair. The primary predictor variable was frailty as measured by the 5-Factor Modified Frailty Index (mFI-5). The primary outcome variable was the postoperative complication rate. Descriptive, bivariate, and multiple logistic regression statistics were utilized to evaluate the relationship between frailty and complications. RESULTS During the study period, 4,290 subjects underwent operative repair of a facial fracture. Of these subjects, 4,086 (83.0%) were classified as nonfrail, 626 (12.7%) as moderately frail, and 208 (4.20%) as severely frail. A total of 237 subjects experienced a complication (4.82%), and the incidence of complications increased in a stepwise manner with increasing frailty (P ≤ .001). In multivariate regression, age (P = .050, 95% CI = 1.00 to 1.02), Native Hawaiian/Pacific Islander race (P = .018, 95% CI = 1.23 to 8.63), classification as moderately frail (P = .010, 95% CI = 1.15 to 2.66), classification as severely frail (P = .032, 95% CI = 1.06 to 3.70), mandibular fractures (P = .004, 95% CI = 1.24 to 2.98), and wound classification as contaminated (P ≤ .001, 95% CI = 1.53 to 4.57) or dirty/infected (P = .020, 95% CI = 1.16 to 5.55) were independent predictors of complications. Severely frail subjects also had greater length of hospital admission (P ≤ .001) and higher 30-day readmission rates (P ≤ .001). CONCLUSIONS Frailty is an independent predictor of complications following facial fracture repair and is associated with greater length of hospital admission and 30-day readmission rates.
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Affiliation(s)
- Cameron C Lee
- Resident, Oral & Maxillofacial Surgery, Massachusetts General Hospital and Clinical Fellow, Harvard School of Dental Medicine, Boston, MA
| | | | - Jeffrey T Hajibandeh
- Instructor, Oral & Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
| | - Zachary S Peacock
- Associate Professor, Oral & Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
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Mendes ML, Mahl C, Carvalho AC, Santos VS, Tanajura DM, Martins-Filho PR. Frailty and risk of complications in head and neck oncologic surgery. Systematic review and dose-response meta-analysis. Med Oral Patol Oral Cir Bucal 2021; 26:e582-e589. [PMID: 34414998 PMCID: PMC8412444 DOI: 10.4317/medoral.24588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/05/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is emerging evidence that frail individuals present a decreased physiological reserve, decreased ability to maintain homeostasis, and increased vulnerability to stressors. The concept of frailty has become increasingly recognized as a valuable measure in oncological surgical patients, including those with head and neck cancer. Preoperative screening for frailty may provide an individualized risk assessment that can be used by an interdisciplinary team for preoperative counseling and to improve outcomes. The aim of this meta-analysis was to evaluate the relationship between frailty and the risk of major postoperative complications in frail individuals submitted to head and neck oncologic surgery. MATERIAL AND METHODS PubMed, SCOPUS, Web of Science, Google Scholar and OpenThesis were systematically searched to identify studies that evaluated the risk of major postoperative complications in frail individuals undergoing head and neck oncologic surgery. The search was performed on August 31, 2020, without language or date restrictions. Two independent investigators screened the searched studies based on each paper's title and abstract. Relevant studies were read in full and selected according to the eligibility criteria. Frailty was assessed by modified Frailty Index (mFI-11) and major postoperative complications were measured by the Clavien-Dindo classification. We performed a categorical and dose-response meta-analysis using a random-effects model to evaluate the association between frailty and the risk of major postoperative complications in patients submitted to head and neck oncologic surgery. The results of the meta-analysis were expressed as relative risk (RR) and 95% confidence interval (95% CI). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Four studies (9,947 patients) were included in this systematic review and meta-analysis. Frail patients presented an increased risk of life-threatening complications requiring intensive care unit (ICU) admission (RR = 4.67; 95% CI 1.54-14.10) and 30-day mortality (RR = 8.10; 95% CI 2.30-28.57) compared to non-frail patients. We found evidence of dose-response trend between mFI-11 and major postoperative complications. CONCLUSIONS Higher frailty scores are associated with a significant increase in ICU-level complications and 30-day mortality after head and neck oncologic surgery.
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Affiliation(s)
- M-L Mendes
- Universidade Federal de Sergipe, Hospital Universitário Laboratório de Patologia Investigativa Rua Cláudio Batista, s/n. Bairro Sanatório CEP: 49060-100. Aracaju, Sergipe, Brasil
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Hadaya J, Sanaiha Y, Juillard C, Benharash P. Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States. PLoS One 2021; 16:e0255122. [PMID: 34297772 PMCID: PMC8301636 DOI: 10.1371/journal.pone.0255122] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background Frailty has been recognized as an independent risk factor for inferior outcomes, but its effect on emergency general surgery (EGS) is understudied. Objective The purpose of the present study was to define the impact of frailty on risk-adjusted mortality, non-home discharge, and readmission following EGS operations. Methods Adults undergoing appendectomy, cholecystectomy, small bowel resection, large bowel resection, repair of perforated ulcer, or laparotomy within two days of an urgent admission were identified in the 2016–2017 Nationwide Readmissions Database. Frailty was defined using diagnosis codes corresponding to the Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable regression was used to study in-hospital mortality and non-home discharge by operation, and Kaplan Meier analysis to study freedom from unplanned readmission at up to 90-days follow-up. Results Among 655,817 patients, 11.9% were considered frail. Frail patients most commonly underwent large bowel resection (37.3%) and cholecystectomy (29.2%). After adjustment, frail patients had higher mortality rates for all operations compared to nonfrail, including those most commonly performed (11.9% [95% CI 11.4–12.5%] vs 6.0% [95% CI 5.8–6.3%] for large bowel resection; 2.3% [95% CI 2.0–2.6%] vs 0.2% [95% CI 0.2–0.2%] for cholecystectomy). Adjusted non-home discharge rates were higher for frail compared to nonfrail patients following all operations, including large bowel resection (68.1% [95% CI 67.1–69.0%] vs 25.9% [95% CI 25.2–26.5%]) and cholecystectomy (33.7% [95% CI 32.7–34.7%] vs 2.9% [95% CI 2.8–3.0%]). Adjusted hospitalization costs were nearly twice as high for frail patients. On Kaplan-Meier analysis, frail patients had greater unplanned readmissions (log rank P<0.001), with 1 in 4 rehospitalized within 90 days. Conclusions Frail patients have inferior clinical outcomes and greater resource use following EGS, with the greatest absolute differences following complex operations. Simple frailty assessments may inform expectations, identify patients at risk of poor outcomes, and guide the need for more intensive postoperative care.
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Affiliation(s)
- Joseph Hadaya
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Division of General Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Yas Sanaiha
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Division of General Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Catherine Juillard
- Division of General Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Peyman Benharash
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- * E-mail:
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Henry RK, Uppuluri A, Langer PD, Zarbin MA, Bhagat N. The Impact of Frailty on Outcomes of Open-Globe Injury in the Geriatric Population. Ophthalmol Retina 2021; 5:1285-1287. [PMID: 34284166 DOI: 10.1016/j.oret.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Roger K Henry
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Rutgers University, Newark, New Jersey
| | - Aditya Uppuluri
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Rutgers University, Newark, New Jersey
| | - Paul D Langer
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Rutgers University, Newark, New Jersey
| | - Marco A Zarbin
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Rutgers University, Newark, New Jersey
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Rutgers University, Newark, New Jersey.
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Shahrestani S, Bakhsheshian J, Solaru S, Ton A, Ballatori AM, Chen XT, Ariani R, Hsieh P, Buser Z, Wang JC. Inclusion of Frailty Improves Predictive Modeling for Postoperative Outcomes in Surgical Management of Primary and Secondary Lumbar Spine Tumors. World Neurosurg 2021; 153:e454-e463. [PMID: 34242828 DOI: 10.1016/j.wneu.2021.06.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malignant spinal tumors are common, continually increasing in incidence as a function of improved survival times for patients with cancer. Using predictive analytics and propensity score matching, we evaluated the influence of frailty on postoperative complications compared with age in patients with malignant neoplasms of the lumbar spine. METHODS We used the Nationwide Readmissions Database from 2016 and 2017 to identify patients with malignant neoplasms of the lumbar spine who received a fusion procedure. Patient frailty was queried using the Johns Hopkins Adjusted Clinical Groups. Propensity score matching for age, sex, Charlson Comorbidity Index, surgical approach, and number of levels fused was implemented between frail and nonfrail patients, identifying 533 frail patients and 538 nonfrail patients. The area under the curve (AUC) of each ROC served as a proxy for model performance. RESULTS Frail patients reported significantly higher inpatient lengths of stay, costs, infection, posthemorrhagic anemia, and urinary tract infections (P < 0.05). In addition, frail patients were more often discharged to skilled nursing facilities and short-term hospitals compared with nonfrail patients (P < 0.0001). Regression models for mortality (AUC = 0.644), nonroutine discharge (AUC = 0.600), and acute infection (AUC = 0.666) were improved when using frailty as the primary predictor. These models were also improved using frailty when predicting 30-day readmission and 90-day hardware failure. CONCLUSIONS Frailty demonstrated a significant relationship with increased postoperative patient complications, length of stay, costs, and acute complications in patients receiving fusion following resection of a malignant neoplasm of the lumbar spine region. Frailty demonstrated better predictive validity of outcomes compared with patient age.
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Affiliation(s)
- Shane Shahrestani
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Department of Medical Engineering, California Institute of Technology, Pasadena, California, USA
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Samantha Solaru
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Andy Ton
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexander M Ballatori
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Xiao T Chen
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Rojine Ariani
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Patrick Hsieh
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Zorica Buser
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | - Jeffrey C Wang
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Dobaria V, Hadaya J, Sanaiha Y, Aguayo E, Sareh S, Benharash P. The Pragmatic Impact of Frailty on Outcomes of Coronary Artery Bypass Grafting. Ann Thorac Surg 2021; 112:108-115. [DOI: 10.1016/j.athoracsur.2020.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/12/2020] [Accepted: 08/18/2021] [Indexed: 12/14/2022]
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Pruitt SL, Gerber DE, Zhu H, Heitjan DF, Maddineni B, Xiong D, Singal AG, Tavakkoli A, Halm EA, Murphy CC. Survival of patients newly diagnosed with colorectal cancer and with a history of previous cancer. Cancer Med 2021; 10:4752-4767. [PMID: 34190429 PMCID: PMC8290226 DOI: 10.1002/cam4.4036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with previous cancer are often excluded from clinical trials despite limited evidence about their prognosis. We examined the effect of previous cancer on overall and colorectal cancer (CRC)-specific survival of patients newly diagnosed with CRC. This population-based cohort study from the U.S.A. included patients aged ≥66 years and diagnosed with CRC between 2005 and 2015 in linked Surveillance, Epidemiology, and End Results-Medicare data. We estimated the stage-specific effects of a previous cancer on overall survival using Cox regression and on CRC-specific survival using competing risk regression. We also examined the effect of previous cancer type, timing, and stage on overall survival. Of 112,769 patients, 14.1% were previously diagnosed with another cancer--commonly prostate (32.9%) or breast (19.4%) cancer, with many (47.1%) diagnosed <5 years of CRC. For all CRC stages except IV, in which there was no difference, patients with previous cancer (vs. without) had worse overall survival. However, patients with previous cancer had improved CRC-specific survival. Overall survival for those with stage 0-III CRC varied by previous cancer type, timing, and stage; for example, patients with previous melanoma had overall survival equivalent to those with no previous cancer. Our results indicate that, in general, CRC patients with previous cancer have worse overall survival but superior CRC-specific survival. Given their equivalent survival to those without previous cancer, patients with previous melanoma and those with stage IV CRC with any type of previous cancer should be eligible to participate in clinical trials.
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Affiliation(s)
- Sandi L Pruitt
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - David E Gerber
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hong Zhu
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Daniel F Heitjan
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Bhumika Maddineni
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Danyi Xiong
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Amit G Singal
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anna Tavakkoli
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ethan A Halm
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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Hadaya J, Mandelbaum A, Sanaiha Y, Benharash P. Impact of Frailty on Clinical Outcomes and Hospitalization Costs Following Elective Colectomy. Am Surg 2021; 87:1589-1593. [PMID: 34126791 DOI: 10.1177/00031348211024233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Frailty has been increasingly recognized as a risk factor for inferior surgical outcomes and greater resource use. The present study evaluated the impact of a coding-based frailty tool on outcomes of elective colectomy in a national cohort. STUDY DESIGN Adults undergoing elective colectomy were identified in the 2016-17 Nationwide Readmissions Database. Frailty was defined using the Johns Hopkins 10-domain coding-based binary tool. Generalized linear models were used to examine the association of frailty with in-hospital mortality, nonhome discharge, hospitalization duration (LOS), and inflation-adjusted costs. Kaplan-Meier survival analysis and log-rank test was used to compare readmissions up to 1-year. RESULTS Of 133 175 patients, 10.6% were considered frail. The most common resections were sigmoid (43.9%) and right (34.7%) while total colectomy was least common (2.8%). After adjustment, frailty was associated with greater odds of mortality (3.2, 95% CI 2.8-3.8) and nonhome discharge (6.0, 95% CI 5.5-6.4) as well as a $13,400-increment (95% CI 12,400-14,400) in costs and 4.4-day (95% CI 4.1-4.6) increase in LOS. Nonelective readmissions at 30 days were greater in frail than non-frail groups (14.7% vs. 10.4%, P < .001). CONCLUSION Frailty is associated with inferior clinical outcomes and increased resource use following elective colectomy. Inclusion of frailty in risk models may facilitate risk stratification and shared decision-making.
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Affiliation(s)
- Joseph Hadaya
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ava Mandelbaum
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yas Sanaiha
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peyman Benharash
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Bras L, de Vries J, Festen S, Steenbakkers RJHM, Langendijk JA, Witjes MJH, van der Laan BFAM, de Bock GH, Halmos GB. Frailty and restrictions in geriatric domains are associated with surgical complications but not with radiation-induced acute toxicity in head and neck cancer patients: A prospective study. Oral Oncol 2021; 118:105329. [PMID: 34111770 DOI: 10.1016/j.oraloncology.2021.105329] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We aimed to evaluate the association between frailty screening and geriatric assessment (GA) on short term adverse events in patients treated for head and neck cancer (HNC) for the first time in a prospective study. MATERIALS AND METHODS Newly diagnosed HNC patients undergoing curative treatment were prospectively included in OncoLifeS, a data biobank. Prior to the start of treatment, frailty was assessed with a GA, Groningen Frailty Indicator (GFI) and Geriatric-8 (G8). The GA included comorbidity (Adult Comorbidity Evaluation - 27), nutritional status (Malnutrition Universal Screening Tool), functional status ((instrumental) Activities of Daily Living), mobility (Timed Up & Go), psychological (Geriatric Depression Scale 15) and cognitive (Mini Mental State Examination) measures. Clinically relevant postoperative complications (Clavien-Dindo ≥ grade 2) and acute radiation-induced toxicity (Common Terminology Criteria for Adverse Events version 4.0 ≥ grade 2) were defined as outcome measures. Univariable and multivariable logistic regression analyses were performed, yielding odds ratios (ORs) and 95% confidence intervals (95%CIs). RESULTS Of the 369 included patients, 259 patients were eligible for analysis. Postoperative complications occurred in 41/148 (27.7%) patients and acute radiation-induced toxicity was present in 86/160 (53.7%) patients. Number of deficit domains of GA (OR = 1.71, 95%CI = 1.14-2.56), GFI (OR = 2.54, 95%CI = 1.02-6.31) and G8 (OR5.59, 95%CI = 2.14-14.60) were associated with postoperative complications, but not with radiation-induced toxicity. CONCLUSION Frailty and restrictions in geriatric domains were associated with postoperative complications, but not with radiation-induced acute toxicity in curatively treated HNC patients. The results of this prospective study further emphasizes the importance of geriatric evaluation, particularly before surgery.
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Affiliation(s)
- Linda Bras
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands.
| | - Julius de Vries
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Suzanne Festen
- University Center for Geriatric Medicine, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO box 30.001, 9700 RB, Groningen, the Netherlands
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Pruitt SL, Zhu H, Heitjan DF, Rahimi A, Maddineni B, Tavakkoli A, Halm EA, Gerber DE, Xiong D, Murphy CC. Survival of women diagnosed with breast cancer and who have survived a previous cancer. Breast Cancer Res Treat 2021; 187:853-865. [PMID: 33620590 PMCID: PMC8318112 DOI: 10.1007/s10549-021-06122-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Many women diagnosed with breast cancer have survived previous cancer; yet little is known about the impact of previous cancer on overall and cancer-specific survival. METHODS This population-based cohort study using SEER-Medicare data included women (age ≥ 66 years) diagnosed with breast cancer between 2005 and 2015. Separately by breast cancer stage, we estimated effect of previous cancer on overall survival using Cox regression and on cause-specific survival using competing risk regression; all survival analyses adjusted for covariates. RESULTS Of 138,576 women diagnosed with breast cancer, 8% had a previous cancer of another organ site, most commonly colorectal or uterine cancer or melanoma. Many of these women (46.3%) were diagnosed within 5 years of breast cancer. For all breast cancer stages except IV wherein there was no difference, women with vs. without previous cancer had worse overall survival. This survival disadvantage was driven by deaths due to the previous cancer and other causes. In contrast, women with previous cancer generally had favorable breast-cancer-specific survival, although this varied by stage. Overall survival varied by previous cancer type, timing, and stage; previous lung cancer, cancer diagnosed within 1 year of incident breast cancer, and previous cancer at a distant stage were associated with the worst survival. In contrast, women with a previous melanoma had equivalent overall survival to women without previous cancer. CONCLUSION We observed variable impact of previous cancer on overall and breast-cancer-specific survival depending on breast cancer stage at diagnosis and the type, timing, and stage of previous cancer.
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Affiliation(s)
- Sandi L Pruitt
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Hong Zhu
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Daniel F Heitjan
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Asal Rahimi
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bhumika Maddineni
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Anna Tavakkoli
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ethan A Halm
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David E Gerber
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Danyi Xiong
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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Goshtasbi K, Birkenbeuel JL, Lehrich BM, Abiri A, Haidar YM, Tjoa T, Kuan EC. Association Between 5-Item Modified Frailty Index and Short-term Outcomes in Complex Head and Neck Surgery. Otolaryngol Head Neck Surg 2021; 166:482-489. [PMID: 33971756 DOI: 10.1177/01945998211010443] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Brandon M Lehrich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
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Volk L, Chao J, Dombrovskiy V, Ikegami H, Russo MJ, Lemaire A, Lee LY. Impact of risk factors on in-hospital mortality for octogenarians undergoing cardiac surgery. J Card Surg 2021; 36:2400-2406. [PMID: 33821496 DOI: 10.1111/jocs.15532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/22/2020] [Accepted: 01/21/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Octogenarians undergoing cardiac surgery have higher mortality than their younger counterparts. OBJECTIVES To determine if various risk factors have the same effect on mortality in octogenarians as in younger patients. METHODS The National Inpatient Sample data set from 2004 to 2014 was queried to select patients aged 65 years and older who underwent either coronary artery bypass grafting (CABG), valvular heart surgery (VHS), or both (CABG + VHS) within 10 days of hospital admission. The patients were divided into two groups 65-79 years and 80 years and greater. Hospital mortality, patient demographics, comorbidities, and type of hospital admission was evaluated and compared using χ2 and multivariable logistic regressions. RESULTS About 397,713 patients were identified including 86,345 (21.7%) aged 80 and above. Octogenarians had higher in-hospital mortality for all procedures: CABG (4.94% vs. 2.39%, p < .001), VHS (5.49% vs. 4.08%, p < .001), and CABG + VHS (7.59% vs. 5.95%, p < .001), and this relationship persisted when gender, race, comorbidities, and type of hospital admission were controlled for: CABG (odds ratio [OR] = 1.71; 95% confidence interval [CI] 1.62-1.81); VHS (OR = 1.18; 95% CI 1.11-1.27); and CABH + VHS (OR = 1.17; 95%CI 1.10-1.26). Female gender, renal, or heart failure, nonelective admission, and CABG + VHS were associated with increased risk of in-hospital mortality. Octogenarians had higher rates of these factors (p < .001). The effect size of renal and heart failure and type of surgery was smaller for octogenarians. CONCLUSIONS Octogenarians undergoing cardiac surgery have higher rates of nonelective admissions, renal and heart failure, and female gender, which are most strongly associated with in-hospital mortality. Differing effect sizes suggest that certain risk factors, such as renal and heart failure, contribute more to mortality in younger patients.
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Affiliation(s)
- Lindsay Volk
- Department of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Joshua Chao
- Department of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Viktor Dombrovskiy
- Department of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Hirohisa Ikegami
- Department of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mark J Russo
- Department of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Anthony Lemaire
- Department of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Leonard Y Lee
- Department of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Cohen SM, Porter Starr KN, Risoli T, Lee HJ, Misono S, Jones H, Raman S. Association between Dysphagia and Surgical Outcomes across the Continuum of Frailty. J Nutr Gerontol Geriatr 2021; 40:59-79. [PMID: 34048333 PMCID: PMC10439529 DOI: 10.1080/21551197.2021.1929644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study examined the relationship between dysphagia and adverse outcomes across frailty conditions among surgical patients ≥50 years of age. A retrospective cohort analysis of surgical hospitalizations in the Healthcare Cost and Utilization Project's National Inpatient Sample among patients ≥50 years of age undergoing intermediate/high risk surgery not involving the larynx, pharynx, or esophagus. Of 3,298,835 weighted surgical hospitalizations, dysphagia occurred in 1.2% of all hospitalizations and was higher in frail patients ranging from 5.4% to 11.7%. Dysphagia was associated with greater length of stay, higher total costs, increased non-routine discharges, and increased medical/surgical complications among both frail and non-frail patients. Dysphagia may be an independent risk factor for poor postoperative outcomes among surgical patients ≥50 years of age across frailty conditions and is an important consideration for providers seeking to reduce risk in vulnerable surgical populations.
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Affiliation(s)
- Seth M Cohen
- Department of Head and Neck Surgery and Communication Sciences, Duke Voice Care Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Kathryn N Porter Starr
- Department of Medicine, Center for the Study of Aging, Duke University Medical Center, Durham, North Carolina, USA
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, North Carolina, USA
| | - Thomas Risoli
- Duke CTSI Biostatistics, Epidemiology and Research Design Methods Core, Duke University Medical Center, Durham, North Carolina, USA
| | - Hui-Jie Lee
- Duke CTSI Biostatistics, Epidemiology and Research Design Methods Core, Duke University Medical Center, Durham, North Carolina, USA
| | - Stephanie Misono
- Department of Otolaryngology/Head and Neck Surgery, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota, USA
| | - Harrison Jones
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sudha Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Farrugia M, Erickson K, Wendel E, Platek ME, Ji W, Attwood K, Ma SJ, Gu F, Singh AK, Ray AD. Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy. Cancers (Basel) 2021; 13:cancers13071638. [PMID: 33915867 PMCID: PMC8037640 DOI: 10.3390/cancers13071638] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Quality of life (QoL) scores and frailty status are becoming increasingly important criterion with implications on both how patients are treated and survival in head and neck cancer (HNC). Despite this, physicians lack tools to identify patients who are at risk of suffering declines in QoL and becoming frail following treatment. Therefore, we investigated whether functional decline, as measured by a series of physical tests called the Short Physical Performance Battery (SPPB), correlated with a reduction in QoL and increased risk of frailty. In the current study, patients who experienced a decline in SPPB scores were significantly more likely to have changes in physical functioning QoL measures as well as transition to frail status following treatment. In conclusion, the SPPB may be a useful tool to identify patients who may benefit from additional rehabilitation in future studies. Abstract Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in HNC and was the focus of this investigation. Methods: Patients who underwent radiation therapy for HNC from 2018 to 2020 were evaluated as a prospective observational cohort. Functional decline, QoL, and the frailty phenotype were measured via the Short Physical Performance Battery (SPPB), European Organization for Research and Treatment of Cancer (EORTC) qlq-C30, and Fried Frailty index, respectively. Results: A total of 106 HNC patients were included, 75 of which received concurrent chemoradiation therapy (CCRT) and 31 received radiation alone, both with and without surgery. There was a decrease in SPPB overall (p < 0.001) from the beginning to the end of treatment in the CCRT group but not the radiation group (p = 0.43). Change in overall SPPB points following treatment correlated with the decline in physical QoL for both groups (p < 0.05) as well as transition frail status in the CCRT group (p < 0.001) with a trend in the radiation group (p = 0.08). Conclusions: Change in SPPB correlates with QoL and transition to frailty status in patients undergoing definitive CCRT for HNC with similar trends in those receiving radiation alone. Decline in SPPB could potentially be useful in identification of those who may benefit from rehabilitation in future studies.
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Affiliation(s)
- Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Kayleigh Erickson
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Elizabeth Wendel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Dietetics, D’Youville College, Buffalo, NY 14203, USA
| | - Wenyan Ji
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Fangyi Gu
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Andrew D. Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Rehabilitation Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
- Correspondence: ; Tel.: +1-716-845-2381; Fax: +1-716-845-8487
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Henry RK, Reeves RA, Wackym PA, Ahmed OH, Hanft SJ, Kwong KM. Frailty as a Predictor of Postoperative Complications Following Skull Base Surgery. Laryngoscope 2021; 131:1977-1984. [PMID: 33645657 DOI: 10.1002/lary.29485] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/23/2021] [Accepted: 02/16/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE/HYPOTHESIS Frailty has emerged as a powerful risk stratification tool across surgical specialties; however, an analysis of the impact of frailty on outcomes following skull base surgery has not been published. The aim of this study was to assess the validity of the 5-factor modified frailty index (mFI-5) as a predictor of perioperative morbidity and mortality in patients undergoing skull base surgery. METHODS A mFI-5 score was calculated for patients undergoing skull base surgeries using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2018. Multivariate logistic regression analysis was used to evaluate the association of increasing frailty with complications in the 30-day postoperative period, with a subanalysis by operative location. RESULTS A total of 17,912 patients who underwent skull base procedures were identified, with 45.5% of patients having a frailty score of one or greater; 44.9% were male and the mean age was 52.0 (±16.1 SD) years. Multivariable regression analysis revealed frailty to be an independent predictor of overall complications (odds ratio [OR]: 1.325, P < .001), life-threatening complications (OR: 1.428, P < .001), and mortality (OR: 1.453, P < .001). Higher frailty also correlated with increased length of stay. When procedures were stratified by operative location, frailty correlated significantly with overall complications for middle, posterior, and multiple-fossae operations but not the anterior fossa. CONCLUSIONS Frailty demonstrates a significant and stepwise association with life-threatening postoperative morbidity, mortality, and length of stay following skull base surgeries. mFI-5 is an objective and easily calculable measure of preoperative risk, which may facilitate perioperative planning and counseling regarding outcomes prior to surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1977-1984, 2021.
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Affiliation(s)
- Roger K Henry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Russell A Reeves
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - P Ashley Wackym
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Omar H Ahmed
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Simon J Hanft
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, U.S.A
| | - Kelvin M Kwong
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
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Mandelbaum AD, Hadaya J, Ulloa JG, Patel R, McCallum JC, De Virgilio C, Benharash P. Impact of Frailty on Clinical Outcomes after Carotid Artery Revascularization. Ann Vasc Surg 2021; 74:111-121. [PMID: 33556528 DOI: 10.1016/j.avsg.2020.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Frailty has been increasingly recognized as an important risk factor for vascular procedures. To assess the impact of frailty on clinical outcomes and resource utilization in patients undergoing carotid revascularization using a national cohort. METHODS The 2005-2017 National Inpatient Sample was used to identify patients who underwent carotid endarterectomy (CEA) or carotid stenting (CAS). Patients were classified as frail using diagnosis codes defined by the Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable regression was used to evaluate associations between frailty and in-hospital mortality, postoperative stroke, myocardial infarction (MI), hospitalization costs, and length of stay (LOS). RESULTS Of 1,426,343 patients undergoing carotid revascularization, 59,158 (4.2%) were identified as frail. Among frail patients, 79.4% underwent CEA and 20.6% underwent CAS. Compared to CEA, a greater proportion of patients undergoing CAS were frail (6.0% vs. 3.8%, P < 0.001). Compared to the nonfrail cohort, frail patients had higher rates of mortality (2.2% vs. 0.5%, P < 0.001), postoperative stroke (2.6% vs. 1.0%, P < 0.001), MI (2.2% vs. 0.8%, P < 0.001), and stroke/death (4.4% vs. 1.4%, P < 0.001). After adjustment, frailty was associated with increased odds of mortality (AOR = 1.59, 95% CI: 1.30-1.80, P < 0.001), stroke (AOR = 1.66, 95% CI: 1.38-1.83 P < 0.001), MI (AOR = 1.51, 95% CI: 1.29-1.72, P < 0.001), and stroke/death (AOR = 1.62, 95% CI: 1.45-1.81, P < 0.001). Furthermore, frailty was associated with increased hospitalization costs (β = +$5,980, 95% CI: $5,490-$6,470, P < 0.001) and LOS (β = +2.6 days, 95% CI: 2.4-2.8, P < 0.001). CONCLUSIONS Frailty is associated with adverse outcomes and greater resource use for those undergoing carotid revascularization. Risk models should include an assessment of frailty to guide management and improve outcomes for these high-risk patients.
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Affiliation(s)
- Ava D Mandelbaum
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jesus G Ulloa
- Division of Vascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Rhusheet Patel
- Division of Vascular Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - John C McCallum
- Department of Surgery, Harbor UCLA Medical Center, Torrance, CA
| | | | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
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Thomas CM, Sklar MC, Su J, Xu W, De Almeida JR, Alibhai SMH, Goldstein DP. Longitudinal Assessment of Frailty and Quality of Life in Patients Undergoing Head and Neck Surgery. Laryngoscope 2021; 131:E2232-E2242. [PMID: 33427307 DOI: 10.1002/lary.29375] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To understand changes in frailty and quality of life (QOL) in frail versus non-frail patients undergoing surgery for head and neck cancer (HNC). METHODS Prospective cohort study of patients (median age 67 (50, 88)) with HNC undergoing surgery from December 2011 to April 2014. Fried's Frailty Index, Vulnerable Elders Survey (VES-13), and comprehensive QOL assessments (EORTC QLQ-C30 and HN35) were completed at baseline and 3, 6, and 12-month post-operative visits. Change in frailty and QOL over time was compared between frailty groups (non-frail (score 0), pre-frail (score 1-2), and frail (score 3-5)) using a mixed effects model. Predictors of long-term elevated frailty (12 months > baseline) were analyzed using logistic regression. RESULTS The study had 108 patients classified as non-frail (47%), 104 pre-frail (mean (SD) 1.3 (0.4), 45%), and 17 frail (3.4 (0.6); 7%). Frailty score decreased significantly for frail patients 3 months post-operatively (2.1 (1.0); P = .002) and remained significantly lower than baseline at 6 and 12 months (2.1 (1.4); P = .0008 and 2.2 (1.5); P = .005, respectively) while frailty score increased for non-frail patients at 3 months (1.1 (1.0); P < .001) and then decreased. Forty-eight patients (21%) had long-term elevated frailty, with baseline frailty and marital status identified as predictors on univariate analysis. The frail population had significantly worse QOL scores at baseline, which persisted 12 months post-operatively. CONCLUSIONS Frail patients demonstrate a decrease in frailty score following surgical treatment of HNC. Frail patients have significantly worse QOL scores on longitudinal assessment and would benefit from supportive services throughout their care. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2232-E2242, 2021.
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Affiliation(s)
- Carissa M Thomas
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael C Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Hospital/University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Hospital/University Health Network and University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - John R De Almeida
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,The Institute of Health Policy, Management, and Evaluation and the Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Jones AJ, Campiti VJ, Alwani M, Novinger LJ, Bonetto A, Sim MW, Yesensky JA, Moore MG, Mantravadi AV. Skeletal Muscle Index's Impact on Discharge Disposition After Head and Neck Cancer Free Flap Reconstruction. Otolaryngol Head Neck Surg 2020; 165:59-68. [PMID: 33290190 DOI: 10.1177/0194599820973232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the role of skeletal muscle index (SMI) in the assessment of frailty and determination of discharge to post-acute care facilities (PACF) after head and neck cancer free flap reconstruction (HNCFFR). STUDY DESIGN Retrospective cohort. SETTING Single-institution, academic tertiary referral center. METHODS Adult patients undergoing HNCFFR from 2014 to 2019 with preoperative abdominal computed tomography imaging were retrospectively analyzed. Patient demographics, 5-factor modified frailty index (5-mFI), body mass index (BMI), SMI at the third lumbar vertebra, oncologic history, perioperative data, and Clavien-Dindo (CD) complications were collected. Binary logistic regression was used to identify independent predictors of discharge disposition. RESULTS The cohort consisted of 206 patients, 62 (30.1%) of whom were discharged to PACF. Patients discharged to PACF were of older age (65.4 vs 57.1 years, P < .0001) and had a lower SMI (38.8 vs 46.8 cm2/m2, P < .0001), higher 5-mFI (≥3; 25.8% vs 4.2%, P < .0001), and greater incidence of stage IV (80.6% vs 64.1%, P = .0211) aerodigestive cancer (80.6% vs 66.7%, P = .0462). Patients discharged to PACF experienced more blood transfusions (74.2% vs 35.4%, P < .0001), major postoperative complications (CD ≥3, 40.3% vs 12.9%, P < .0001), and delirium (33.9% vs 4.2%, P < .0001). After adjusting for pre- and postoperative factors, multivariate binary logistic regression identified age (P = .0255), 5-mFI (P < .0042), SMI (P = .0199), stage IV cancer (P = .0250), aerodigestive tumor (P = .0366), delirium (P < .0001), and perioperative blood transfusion (P = .0144) as independent predictors of discharge to PACF. CONCLUSIONS SMI and 5-mFI are independently associated with discharge to PACF after HNCFFR and should be considered in preoperative planning and assessment of frailty.
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Affiliation(s)
- Alexander Joseph Jones
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Mohamedkazim Alwani
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leah J Novinger
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrea Bonetto
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael W Sim
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica A Yesensky
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael G Moore
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Avinash V Mantravadi
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Karunungan KL, Hadaya J, Tran Z, Sanaiha Y, Mandelbaum A, Revels SL, Benharash P. Frailty Is Independently Associated With Worse Outcomes After Elective Anatomic Lung Resection. Ann Thorac Surg 2020; 112:1639-1646. [PMID: 33253672 DOI: 10.1016/j.athoracsur.2020.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Frailty has been widely recognized as a predictor of postoperative outcomes. Given the paucity of standardized frailty measurements in thoracic procedures, this study aimed to determine the impact of coding-based frailty on clinical outcomes and resource use after anatomic lung resection. METHODS All adults undergoing elective, anatomic lung resections (segmentectomy, lobectomy, pneumonectomy) from 2005 to 2014 were identified using the National Inpatient Sample. Patients were categorized as either frail or nonfrail on the basis of the presence of any frailty-defining diagnoses defined by the Johns Hopkins Adjusted Clinical Groups. Multivariable models were used to assess the independent association of frailty with in-hospital mortality, nonhome discharge, complications, duration of stay, and costs. RESULTS Of an estimated 366,357 hospitalizations for elective lung resection during the study period, 4.4% were in frail patients. Patients who underwent pneumonectomy or were treated at low-volume hospitals were more commonly frail. Relative to nonfrail patients, frailty was associated with increased unadjusted mortality (9.1% vs 1.7%; P < .001) and nonhome discharge (44.7% vs 10.5%; P < .001). Frail patients had 3.47 increased adjusted odds of mortality across resection types (95% confidence interval, 2.94 to 4.09). Frailty conferred the greatest increase in mortality, complications, and resource use after pneumonectomy relative to lobectomy or segmentectomy, although significant differences were evident for all 3 operations. CONCLUSIONS Frailty exhibits a strong association with inferior clinical outcomes and increased resource use after elective lung resection, particularly pneumonectomy. This readily available tool may improve preoperative risk assessment and allow for better selection of treatment modalities for frail patients with pulmonary disorders.
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Affiliation(s)
- Krystal L Karunungan
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California; Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California
| | - Ava Mandelbaum
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California
| | - Sha'Shonda L Revels
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California; Division of Thoracic Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California; Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California.
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