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Nicaise EH, Palmateer G, Schmeusser BN, Futral C, Liu Y, Goyal S, Nabavizadeh R, Kooby DA, Maithel SK, Sweeney JF, Sarmiento JM, Ogan K, Master VA. Differences in preoperative frailty assessment of surgical candidates by sex, age, and race. Surg Open Sci 2024; 19:172-177. [PMID: 38779040 PMCID: PMC11109462 DOI: 10.1016/j.sopen.2024.05.003] [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: 04/01/2024] [Revised: 04/10/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Surgical decision-making often relies on a surgeon's subjective assessment of a patient's frailty status to undergo surgery. Certain patient demographics can influence subjective judgment when compared to validated objective assessments. In this study, we explore the relationship between subjective and objective frailty assessments according to patient age, sex, and race. Methods Patients were prospectively enrolled in urology, general surgery, and surgical oncology clinics. Using a visual analog scale (0-100), operating surgeons independently rated the patient's frailty status. Objective frailty was classified using the Fried Frailty Criteria ranging from 0 to 5. Multivariable proportional odds models were conducted to examine the potential association of factors with objective frailty, according to surgeon frailty rating. Subgroup analysis according to patient sex, race, and age was also performed. Results Seven male surgeons assessed 203 patients preoperatively with a median age of 65. A majority of patients were male (61 %), white (67 %), and 60 % and 40 % underwent urologic and general surgery/surgical oncology procedures respectively. Increased subjective surgeon rating (OR 1.69; p < 0.001) was significantly associated with the presence of objective frailty. On subgroup analysis, a higher magnitude of such association was observed more in females (OR 1.86; p = 0.0007), non-white (OR 1.84; p = 0.0019), and older (>60, OR 1.75; p = 0.0001) patients, compared to male (OR 1.45; p = 0.0243), non-white (OR 1.48; p = 0.0109) and patients under 60 (OR 1.47; p = 0.0823). Conclusion The surgeon's subjective assessment of frailty demonstrated tendencies to rate older, female, and non-white patients as frail; however, differences in patient sex, age, and race were not statistically significant.
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Affiliation(s)
- Edouard H. Nicaise
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Gregory Palmateer
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Benjamin N. Schmeusser
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States of America
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Cameron Futral
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Yuan Liu
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Subir Goyal
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Reza Nabavizadeh
- Department of Urology, Mayo Clinic, Rochester, MN, United States of America
| | - David A. Kooby
- Department of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, United States of America
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Shishir K. Maithel
- Department of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, United States of America
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, United States of America
| | - John F. Sweeney
- Department of General Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Juan M. Sarmiento
- Department of General Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Viraj A. Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, United States of America
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, United States of America
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2
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Summerfield C, Smith L, Todd O, Renzi C, Lyratzopoulos G, Neal RD, Jones D. The Effect of Older Age and Frailty on the Time to Diagnosis of Cancer: A Connected Bradford Electronic Health Records Study. Cancers (Basel) 2022; 14:5666. [PMID: 36428757 PMCID: PMC9688630 DOI: 10.3390/cancers14225666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Over 60% of cancer diagnoses in the UK are in patients aged 65 and over. Cancer diagnosis and treatment in older adults is complicated by the presence of frailty, which is associated with lower survival rates and poorer quality of life. This population-based cohort study used a longitudinal database to calculate the time between presentation to primary care with a symptom suspicious of cancer and a confirmed cancer diagnosis for 7460 patients in the Bradford District. Individual frailty scores were calculated using the electronic frailty index (eFI) and categorised by severity. The median time from symptomatic presentation to cancer diagnosis for all patients was 48 days (IQR 21-142). 23% of the cohort had some degree of frailty. After adjustment for potential confounders, mild frailty added 7 days (95% CI 3-11), moderate frailty 23 days (95% CI 4-42) and severe frailty 11 days (95% CI -27-48) to the median time to diagnosis compared to not frail patients. Our findings support use of the eFI in primary care to identify and address patient, healthcare and system factors that may contribute to diagnostic delay. We recommend further research to explore patient and clinician factors when investigating cancer in frail patients.
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Affiliation(s)
| | - Lesley Smith
- Clinical and Population Science Department, School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Oliver Todd
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds LS2 9JT, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford BD9 6RJ, UK
| | - Cristina Renzi
- Epidemiology of Cancer Healthcare Outcomes (ECHO) Research Group, Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
- Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Via Olgettina 58, 20132 Milan, Italy
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare Outcomes (ECHO) Research Group, Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Richard D. Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter EX4 4PY, UK
| | - Daniel Jones
- Academic Unit of Primary Care, University of Leeds, Leeds LS2 9JT, UK
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3
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Curry SD, Hatch JL, Surdell DL, Gard AP, Casazza GC. Frailty in middle cranial fossa approach for encephalocele or cerebrospinal fluid leak repair. Laryngoscope Investig Otolaryngol 2022; 7:2043-2049. [PMID: 36544962 PMCID: PMC9764798 DOI: 10.1002/lio2.946] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The modified 5-item frailty index (mFI-5) is a concise, comorbidity-based risk stratification tool that can predict adverse outcomes after surgery. The goal of this study was to understand the frailty of patients undergoing surgery for temporal encephalocele or cerebrospinal fluid (CSF) leak and the utility of mFI-5 for predicting increased post-operative outcomes. Methods A retrospective review of adults with temporal encephalocele or CSF leak who underwent middle cranial fossa (MCF) approach craniotomies with or without mastoidectomy from January 2015 through August 2021 at a tertiary care academic medical center was performed. Patients who underwent additional surgeries or extended surgical approaches were excluded. The mFI-5 was calculated for all patients. Demographic and clinical data were obtained from the medical record. Results Thirty-six patients underwent 40 MCF approach craniotomies for temporal encephalocele or CSF leak, including three revision cases and one patient with sequential bilateral operations. Mean age was 54.1 ± 10.8 years, and 66.7% were female. In the univariable regression analysis, mFI-5 score, age, and procedure time use were significantly associated with increased hospital length of stay (LOS) but not increased intensive care unit (ICU) LOS. Anesthesia time and lumbar drain were significantly associated with increased hospital LOS and ICU LOS, and they remained significantly associated with increased hospital LOS in the multivariable model. Conclusion Frailty is associated with increased hospital LOS stay among patients undergoing MCF approach for CSF leak or encephalocele. Reducing anesthesia time and avoiding lumbar drain use are potentially modifiable risk factors that can reduce the LOS and associated costs. Level of Evidence 4.
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Affiliation(s)
- Steven D. Curry
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Jonathan L. Hatch
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Daniel L. Surdell
- Department of NeurosurgeryUniversity of Nebraska Medical Center, 988437 Nebraska Medical CenterOmahaNebraskaUSA
| | - Andrew P. Gard
- Department of NeurosurgeryUniversity of Nebraska Medical Center, 988437 Nebraska Medical CenterOmahaNebraskaUSA
| | - Geoffrey C. Casazza
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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4
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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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5
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Lam JYJ, Barras M, Scott IA, Long D, Shafiee Hanjani L, Falconer N. Scoping Review of Studies Evaluating Frailty and Its Association with Medication Harm. Drugs Aging 2022; 39:333-353. [PMID: 35597861 PMCID: PMC9135775 DOI: 10.1007/s40266-022-00940-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 12/03/2022]
Abstract
Introduction Frailty is associated with an increased risk of death and morbid events. Frail individuals are known to have multiple comorbidities which are often associated with polypharmacy. Whilst a relationship between polypharmacy and frailty has been demonstrated, it is not clear if there is an independent relationship between frailty and medication harm. Aims This scoping review aimed to identify and critically appraise studies evaluating medication harm in patients with frailty. Methods PubMed, EMBASE, CINAHL and Cochrane databases were searched from inception until 1 February 2021 using key search terms that are synonymous with frailty (such as frail and frail elderly) and medication harm (such as adverse drug events and adverse drug reactions). To be included, studies must have identified medication harm as a primary or secondary outcome measure, and used a frailty assessment tool to determine frailty, or clearly defined how frailty was assessed. Data were narratively synthesised and presented in tables. The checklist from the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute was used to assess the quality and risk of bias of studies that met the inclusion criteria. Results Of 2685 retrieved abstracts, 24 underwent full-text review and nine studies met the inclusion criteria. Three studies were retrospective cohort studies, and six were prospective observational studies. Six studies comprised two distinct groups of frail and non-frail individuals, and the remaining three studies evaluated medication harm in an entirely frail population. Seven studies used validated frailty tools such as the Clinical Frailty Scale, Fried Frailty Index, and Fried Frailty Phenotype. Two studies measured frailty using self-defined criteria. Overall, frail individuals were at risk of medication harm with rates ranging between 18.7 and 77% across the nine studies. However, whether frailty is an independent predictor of medication harm remains uncertain, as this was only evaluated in one study. The risk of bias assessment identified limitations in methods and reporting with all nine studies. Conclusion This scoping review identified nine studies evaluating medication harm in frail patients. However, all were limited by the methodological quality and inadequate reporting of study factors. There are few high-quality studies that described a relationship between medication harm and frailty. More robust studies are required that examine the independent relationship between frailty and medication harm, after adjusting for all possible confounders and in particular polypharmacy. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00940-3.
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Affiliation(s)
| | - Michael Barras
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.,Department of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ian A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Duncan Long
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Leila Shafiee Hanjani
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Nazanin Falconer
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.,Department of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
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6
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Mattsson G, Gonzalez Lindh M, Razmi R, Forslin M, Parenmark F, Bandert A, Ehrenborg C, Palm A. Clinical frailty scale as a predictor of disease severity in patients hospitalised with COVID-19 - an observational cohort study. Infect Dis (Lond) 2022; 54:583-590. [PMID: 35394408 DOI: 10.1080/23744235.2022.2060304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 pandemic makes proper resource allocation and prioritisation important. Frailty increases the risk of adverse outcomes and can be quantified using the Clinical frailty scale. The aim of this study was to determine the role of the Clinical frailty scale, in patients ≥65 years of age with coronavirus disease 2019, as a risk factor either for critical coronavirus disease 2019 measured as intensive care unit admission or death or as a risk factor for death. METHODS This was a retrospective observational study on patients ≥65 years hospitalised with coronavirus disease 2019 verified by polymerase chain reaction between 5 March 5 and 5 July 2020. The association between Clinical frailty scale and the composite primary outcome intensive care unit admission or death within 30 days post hospitalisation and the secondary outcome death within 30 days post hospitalisation was analysed using multivariable logistic regression models adjusting for gender, age, body mass index, hypertension, and diabetes. Clinical frailty scale was used as a categorical variable (fit score 1-4, frail score 5-6, and severely frail score 7-9). RESULTS In total, 169 patients were included (47.3% women, mean age 79.2 ± 7.8 years). In the fully adjusted model, adjusted odds ratio for intensive care unit admission or death was 1.84 (95%-confidence interval 0.67-5.03, p = .234) for frail and 6.08 (1.70-21.81, p = .006) for severely frail compared to fit patients. For death, adjusted odds ratio was 2.81 (0.89-8.88, p = .079) for frail and 9.82 (2.53-38.10, p = .001) for severely frail compared to fit patients. CONCLUSIONS A high Clinical frailty scale score was an independent risk factor for the composite outcome intensive care unit admission or death and for the secondary outcome death.
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Affiliation(s)
- Gustav Mattsson
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Margareta Gonzalez Lindh
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.,Department of Neuroscience, Speech and Language Pathology, Uppsala University, Uppsala, Sweden
| | - Robin Razmi
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.,Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mia Forslin
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Fredric Parenmark
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.,Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Bandert
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.,Section of Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Christian Ehrenborg
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.,Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Palm
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.,Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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7
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Marano L, Carbone L, Poto GE, Gambelli M, Nguefack Noudem LL, Grassi G, Manasci F, Curreri G, Giuliani A, Piagnerelli R, Savelli V, Marrelli D, Roviello F, Boccardi V. Handgrip strength predicts length of hospital stay in an abdominal surgical setting: the role of frailty beyond age. Aging Clin Exp Res 2022. [PMID: 35389186 DOI: 10.1007/s40520-022-02121-z/figures/1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Chronological age per se cannot be considered a prognostic risk factor for outcomes after elective surgery, whereas frailty could be. A simple and easy-to-get marker for frailty, such as handgrip strength (HGS), may support the surgeon in decision for an adequate healthcare plan. AIMS The aims of this study were to: (1) determine the prevalence of frailty in an abdominal surgery setting independent of age; (2) evaluate the predictive validity of HGS for the length of hospital stay (LOS). METHODS This is a retrospective study conducted in subjects who underwent abdominal surgical procedures. Only subjects with complete cognitive, functional, nutritional assessments and available measurement of HGS at admission were included. A final cohort of 108 patients were enrolled in the study. RESULTS Subjects had a mean age of 67.8 ± 15.8 years (age range 19-93 years old) and were mostly men. According to Fried's criteria, 17 (15.7%, 4F/13 M) were fit, 58 (23.7%; 24F/34 M) were pre-frail and 33 (30.6%; 20F/13 M) were frail. As expected, HGS significantly differed between groups having frail lower values as compared with pre-frail and fit persons (fit: 32.99 ± 10.34 kg; pre-frail: 27.49 ± 10.35 kg; frail: 15.96 ± 9.52 kg, p < 0.0001). A final regression analysis showed that HGS was significantly and inversely associated with LOS (p = 0.020) independent of multiple covariates, including age. DISCUSSION Most of the population undergoing abdominal surgery is pre-frail or frail. The measurement of handgrip strength is simple and inexpensive, and provides prognostic information for surgical outcomes. Muscle strength, as measured by handgrip dynamometry, is a strong predictor of LOS in a surgical setting.
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Affiliation(s)
- Luigi Marano
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Ludovico Carbone
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Gianmario Edoardo Poto
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Margherita Gambelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Leonelle Lore Nguefack Noudem
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Giulia Grassi
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Fabiana Manasci
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Giulia Curreri
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alessandra Giuliani
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Riccardo Piagnerelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Vinno Savelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Virginia Boccardi
- Section of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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8
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Marano L, Carbone L, Poto GE, Gambelli M, Nguefack Noudem LL, Grassi G, Manasci F, Curreri G, Giuliani A, Piagnerelli R, Savelli V, Marrelli D, Roviello F, Boccardi V. Handgrip strength predicts length of hospital stay in an abdominal surgical setting: the role of frailty beyond age. Aging Clin Exp Res 2022; 34:811-817. [PMID: 35389186 PMCID: PMC9076715 DOI: 10.1007/s40520-022-02121-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/17/2022] [Indexed: 01/12/2023]
Abstract
Background Chronological age per se cannot be considered a prognostic risk factor for outcomes after elective surgery, whereas frailty could be. A simple and easy-to-get marker for frailty, such as handgrip strength (HGS), may support the surgeon in decision for an adequate healthcare plan. Aims The aims of this study were to: (1) determine the prevalence of frailty in an abdominal surgery setting independent of age; (2) evaluate the predictive validity of HGS for the length of hospital stay (LOS). Methods This is a retrospective study conducted in subjects who underwent abdominal surgical procedures. Only subjects with complete cognitive, functional, nutritional assessments and available measurement of HGS at admission were included. A final cohort of 108 patients were enrolled in the study. Results Subjects had a mean age of 67.8 ± 15.8 years (age range 19–93 years old) and were mostly men. According to Fried’s criteria, 17 (15.7%, 4F/13 M) were fit, 58 (23.7%; 24F/34 M) were pre-frail and 33 (30.6%; 20F/13 M) were frail. As expected, HGS significantly differed between groups having frail lower values as compared with pre-frail and fit persons (fit: 32.99 ± 10.34 kg; pre-frail: 27.49 ± 10.35 kg; frail: 15.96 ± 9.52 kg, p < 0.0001). A final regression analysis showed that HGS was significantly and inversely associated with LOS (p = 0.020) independent of multiple covariates, including age. Discussion Most of the population undergoing abdominal surgery is pre-frail or frail. The measurement of handgrip strength is simple and inexpensive, and provides prognostic information for surgical outcomes. Muscle strength, as measured by handgrip dynamometry, is a strong predictor of LOS in a surgical setting.
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Affiliation(s)
- Luigi Marano
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Ludovico Carbone
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Gianmario Edoardo Poto
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Margherita Gambelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Leonelle Lore Nguefack Noudem
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Giulia Grassi
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Fabiana Manasci
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Giulia Curreri
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alessandra Giuliani
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Riccardo Piagnerelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Vinno Savelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Virginia Boccardi
- Section of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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9
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Leiner T, Nemeth D, Hegyi P, Ocskay K, Virag M, Kiss S, Rottler M, Vajda M, Varadi A, Molnar Z. Frailty and Emergency Surgery: Results of a Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:811524. [PMID: 35433739 PMCID: PMC9008569 DOI: 10.3389/fmed.2022.811524] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Frailty, a "syndrome of loss of reserves," is a decade old concept. Initially it was used mainly in geriatrics but lately its use has been extended into other specialties including surgery. Our main objective was to examine the association between frailty and mortality, between frailty and length of hospital stay (LOS) and frailty and readmission within 30 days in the emergency surgical population. Methods Studies reporting on frailty in the emergency surgical population were eligible. MEDLINE (via PubMed), EMBASE, Scopus, CENTRAL, and Web of Science were searched with terms related to acute surgery and frail*. We searched for eligible articles without any restrictions on the 2nd of November 2020. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95% confidence intervals (CI), using a random effect model. Risk of bias assessment was performed according to the recommendations of the Cochrane Collaboration. As the finally selected studies were either prospective or retrospective cohorts, the "Quality In Prognosis Studies" (QUIPS) tool was used. Results At the end of the selection process 21 eligible studies with total 562.070 participants from 8 countries were included in the qualitative and the quantitative synthesis. Patients living with frailty have higher chance of dying within 30 days after an emergency surgical admission (OR: 1.99; CI: 1.76-2.21; p < 0.001). We found a tendency of increased LOS with frailty in acute surgical patients (WMD: 4.75 days; CI: 1.79-7.71; p = 0.002). Patients living with frailty have increased chance of 30-day readmission after discharge (OR: 1.36; CI: 1.06-1.75; p = 0.015). Conclusions Although there is good evidence that living with frailty increases the chance of unfavorable outcomes, further research needs to be done to assess the benefits and costs of frailty screening for emergency surgical patients. Systematic Review Registration The review protocol was registered on the PROSPERO International Prospective Register of Systematic Reviews (CRD42021224689).
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Affiliation(s)
- Tamas Leiner
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Anaesthetic Department, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Huntingdon, United Kingdom
| | - David Nemeth
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Peter Hegyi
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division for Pancreatic Disorders, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Klementina Ocskay
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Marcell Virag
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- Department of Anesthesiology and Intensive Therapy, Szent Gyorgy University Teaching Hospital of Fejer County, Szekesfehervar, Hungary
| | - Szabolcs Kiss
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Mate Rottler
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- Department of Anesthesiology and Intensive Therapy, Szent Gyorgy University Teaching Hospital of Fejer County, Szekesfehervar, Hungary
| | - Matyas Vajda
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Alex Varadi
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Zsolt Molnar
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
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10
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Gordon SA, Aylward A, Patel NS, Bowers C, Presson AP, Smith KR, Foster NL, Gurgel RK. Does Frailty or Age Increase the Risk of Postoperative Complications Following Cochlear Implantation? OTO Open 2021; 5:2473974X211044084. [PMID: 34595366 PMCID: PMC8477701 DOI: 10.1177/2473974x211044084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/14/2021] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate whether frailty or age increases the risk of postoperative complications following cochlear implant (CI) surgery. Study Design Retrospective cohort study. Setting Tertiary academic center. Methods An evaluation of all adult patients undergoing cochlear implantation between 2006 and 2020 was performed. The 5-item Modified Frailty Index (mFI-5, comprising preoperative history of pulmonary disease, heart failure, hypertension, diabetes, and partially/totally dependent functional status) was calculated for all patients included in analysis in addition to demographic characteristics. The primary outcome was postoperative complications following CI within a 3-month period. Major complications included myocardial infarction, bleeding, and cerebrospinal fluid leak, among others. Predictors of postoperative complications were examined using multivariable logistic regression reporting odds ratios (ORs) and 95% CIs. Results There were 520 patients included for review with a median age of 68 (range, 18-94) years and a slight male predominance (n = 283, 54.4%). There were 340 patients (65.4%) who were robust (nonfrail) with an mFI of 0, while 180 (34.6%) had an mFI of ≥1. There were 20 patients who experienced a postoperative complication (3.85%). There was no statistically significant association between postoperative complications as a result of preoperative frailty (OR, 1.56; 95% CI, 0.98-2.48, P = .06) or age as a continuous variable (OR, 0.99; 95% CI, 0.97-1.02, P = .51). Conclusions CI is safe for elderly and frail patients and carries no additional risk of complications when compared to younger, healthier patients. While medical comorbidities should always be considered perioperatively, this study supports the notion that implantation is low risk in older, frail patients.
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Affiliation(s)
- Steven A Gordon
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Alana Aylward
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Neil S Patel
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Christian Bowers
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Angela P Presson
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Ken R Smith
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Norman L Foster
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
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11
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Hewitt J, Carter B, Vilches-Moraga A, Quinn TJ, Braude P, Verduri A, Pearce L, Stechman M, Short R, Price A, Collins JT, Bruce E, Einarsson A, Rickard F, Mitchell E, Holloway M, Hesford J, Barlow-Pay F, Clini E, Myint PK, Moug SJ, McCarthy K. The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. LANCET PUBLIC HEALTH 2020; 5:e444-e451. [PMID: 32619408 PMCID: PMC7326416 DOI: 10.1016/s2468-2667(20)30146-8] [Citation(s) in RCA: 432] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 02/08/2023]
Abstract
Background The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed to establish the prevalence of frailty in patients with COVID-19 who were admitted to hospital and investigate its association with mortality and duration of hospital stay. Methods This was an observational cohort study conducted at ten hospitals in the UK and one in Italy. All adults (≥18 years) admitted to participating hospitals with COVID-19 were included. Patients with incomplete hospital records were excluded. The study analysed routinely generated hospital data for patients with COVID-19. Frailty was assessed by specialist COVID-19 teams using the clinical frailty scale (CFS) and patients were grouped according to their score (1–2=fit; 3–4=vulnerable, but not frail; 5–6=initial signs of frailty but with some degree of independence; and 7–9=severe or very severe frailty). The primary outcome was in-hospital mortality (time from hospital admission to mortality and day-7 mortality). Findings Between Feb 27, and April 28, 2020, we enrolled 1564 patients with COVID-19. The median age was 74 years (IQR 61–83); 903 (57·7%) were men and 661 (42·3%) were women; 425 (27·2%) had died at data cutoff (April 28, 2020). 772 (49·4%) were classed as frail (CFS 5–8) and 27 (1·7%) were classed as terminally ill (CFS 9). Compared with CFS 1–2, the adjusted hazard ratios for time from hospital admission to death were 1·55 (95% CI 1·00–2·41) for CFS 3–4, 1·83 (1·15–2·91) for CFS 5–6, and 2·39 (1·50–3·81) for CFS 7–9, and adjusted odds ratios for day-7 mortality were 1·22 (95% CI 0·63–2·38) for CFS 3–4, 1·62 (0·81–3·26) for CFS 5–6, and 3·12 (1·56–6·24) for CFS 7–9. Interpretation In a large population of patients admitted to hospital with COVID-19, disease outcomes were better predicted by frailty than either age or comorbidity. Our results support the use of CFS to inform decision making about medical care in adult patients admitted to hospital with COVID-19. Funding None.
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Affiliation(s)
- Jonathan Hewitt
- Division of Population Medicine, Department of Surgery, Cardiff University, Cardiff, UK; Aneurin Bevan University Health Board, Caerphilly, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Arturo Vilches-Moraga
- Ageing and Complex Medicine Department, Salford Royal NHS Trust, Manchester, UK; Ageing and Complex Medicine Department, Manchester University, Manchester, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Philip Braude
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alessia Verduri
- Respiratory Unit, University of Modena and Reggio Emilia, University Hospital of Modena Policlinico, Modena, Italy
| | - Lyndsay Pearce
- Department of Colorectal Surgery, Salford Royal NHS Trust, Manchester, UK
| | - Michael Stechman
- Division of Population Medicine, Department of Surgery, Cardiff University, Cardiff, UK
| | - Roxanna Short
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Angeline Price
- Ageing and Complex Medicine Department, Salford Royal NHS Trust, Manchester, UK
| | | | - Eilidh Bruce
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Alice Einarsson
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, UK
| | - Frances Rickard
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Emma Mitchell
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Mark Holloway
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - James Hesford
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Enrico Clini
- Respiratory Unit, University of Modena and Reggio Emilia, University Hospital of Modena Policlinico, Modena, Italy
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Susan J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Kathryn McCarthy
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
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12
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Moug S, Carter B, Myint PK, Hewitt J, McCarthy K, Pearce L. Decision-Making in COVID-19 and Frailty. Geriatrics (Basel) 2020; 5:geriatrics5020030. [PMID: 32384707 PMCID: PMC7344473 DOI: 10.3390/geriatrics5020030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Susan Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley PA2 9PN, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G12 8QQ, UK
- Correspondence: ; Tel.: +44-141-314-6965
| | - Ben Carter
- Trial Statistician, Kings College London, London WC2R 2LS, UK;
| | - Phyo Kyaw Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK;
| | - Jonathan Hewitt
- Department of Population Medicine, Cardiff University, Cardiff CF10 3XQ, UK;
| | - Kathryn McCarthy
- Department of Surgery, North Bristol NHS Trust, Southmead Rd, Bristol BS10 5NB, UK;
| | - Lyndsay Pearce
- Department of Surgery, Salford Royal NHS Foundation Trust, Stott Ln, Salford M6 8HD, UK;
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13
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Psoas Muscle Area Measured with Computed Tomography at Admission to Intensive Care Unit: Prediction of In-Hospital Mortality in Patients with Pulmonary Embolism. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1586707. [PMID: 32219127 PMCID: PMC7081019 DOI: 10.1155/2020/1586707] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 12/19/2022]
Abstract
Aim Sarcopenia, a core component of physical frailty, is an independent risk factor for suboptimal health outcomes in hospitalized patients, especially in the intensive care patients. Psoas muscle areas can be assessed to identify sarcopenia. The aim of this study was to determine the prognostic value of psoas muscle area measured with CT for the prediction of in-hospital mortality in patients with pulmonary embolism at admission to the intensive care unit. Methods Patients with an admission abdominal computed tomography scan and requiring intensive care unit (ICU) stay were reviewed. Selected clinical data of patients admitted to intensive care unit for the management of pulmonary embolism were collected. Using CT scan images at the level of L3 vertebra, the psoas muscle area value was obtained by dividing the sum of the right and left psoas muscle areas into the body surface area. Results In-hospital mortality rate was 22.5% in 89 patients. The pulmonary embolism patients with in-hospital mortality had higher PESI and lower value of psoas muscle area, in addition to the lower systolic blood pressure and arterial oxygen saturation at admission. The increase in the value of psoas muscle area is associated with a decrease in the rate of in-hospital mortality. In patients with in-hospital mortality related to pulmonary embolism, the higher PESI and the lower value of psoas muscle area were considered in accordance with the outcome of patients. Conclusions For the prediction of in-hospital mortality risk in patients with pulmonary embolism managed in intensive care unit, the psoas muscle area value has a merit to be used among the routine diagnostic procedures after further studies conducted with different severity of pulmonary embolism.
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14
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Khan KA, Subramanian T, Richters M, Mubarik A, Saad Abdalla Al-Zawi A, Thorn CC, Chalstrey S, Gunasekera S. Working Collaboratively: Outcomes of Geriatrician Input in Older Patients Undergoing Emergency Laparotomy in a District General Hospital. Cureus 2020; 12:e7069. [PMID: 32104643 PMCID: PMC7039363 DOI: 10.7759/cureus.7069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
With the increasing median age of survival in the UK, there is an increased burden on the provision of medical and surgical care to the population. The 2010 National Confidential Enquiry into Patient Outcome and Death report, "An Age Old Problem," emphasizes the early involvement of surgical and geriatric consultant input to improve perioperative care in older patients. This study describes the development of a Geriatric Surgical Liaison Service aimed at providing consultant-led geriatrician support to improve the outcomes of older patients undergoing Emergency Laparotomy (EL). The primary outcome is the reduction in length of stay (LOS) compared to baseline data prior to geriatrician involvement. The service was designed to include one clinical session involving a consultant geriatrician and two and a half days with a junior doctor in a week. Data was collected prospectively from February 2018 till July 2018 for surgical patients aged ≥ 70 years, who underwent EL, had an inpatient stay of more than seven days, and who were diagnosed with delirium or incurred inpatient falls (intervention group). Baseline data, prior to geriatrician involvement, were collected retrospectively for EL patients aged ≥ 70 years from December 2015 until May 2016. Length of stay and 30-day mortality were also compared between the two cohorts undergoing EL. A total of 69 patients were included in the intervention group; 45 patients underwent EL and their mean LOS was 17.5 days, which was reduced from 22.5 days prior to geriatrician involvement (n=57). There was no difference in median length of stay and 30-day mortality between the retrospective baseline group and the intervention groups. In the intervention group, 8.5% of patients had a new medical diagnosis and 26.8% of patients were offered follow-ups. Although statistically not significant (p=0.40), a shorter stay in hospital by five days can potentially have a positive impact on patient outcomes by reducing psychosocial, cognitive, and functional deconditioning. This would also improve patient flow, release capacity, and waiting times and would be of benefit to the financially strained National Health Service (NHS). Overall, our study suggests that a collaborative, consultant-led geriatric service can improve the management of older surgical patients by potentially reducing length of stay, identifying high-risk patients, and facilitating early and appropriate specialty input alongside adequate and required outpatient follow-up.
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Affiliation(s)
- Kashuf A Khan
- General Surgery, Royal Shrewsbury and Telford National Health Service (NHS) Trust, Shrewsbury, GBR
| | - Thejasvi Subramanian
- General Surgery, Good Hope Hospital, University Hospitals Birmingham, Birmingham, GBR
| | - Megan Richters
- Internal Medicine, Great Western Hospital National Health Service (NHS) Foundation Trust, Swindon, GBR
| | - Ayesha Mubarik
- Family Medicine, Whiston Hospital, St Helens and Knowsley Teaching Hospitals National Health Service (NHS) Trust, Rochdale, GBR
| | | | - Christopher C Thorn
- General Surgery, Great Western Hospital National Health Service (NHS) Foundation Trust, Swindon, GBR
| | - Susan Chalstrey
- Otolaryngology, Great Western Hospital National Health Service (NHS) Foundation Trust, Swindon, GBR
| | - Savithri Gunasekera
- Geriatrics, Frimley Health National Health Service (NHS) Foundation Trust, Frimley, GBR
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15
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Implementation of a Surgical Liaison Service for Elderly Patients: A Single Unit Experience. Geriatrics (Basel) 2019; 4:geriatrics4030046. [PMID: 31357715 PMCID: PMC6787726 DOI: 10.3390/geriatrics4030046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/17/2022] Open
Abstract
Older people over the age of 65 years are recognized as higher risk surgical candidates and it is therefore recommended that their care should be coordinated through a multidisciplinary team (MDT) approach involving senior geriatricians, anaesthetists and surgeons. As one of only a handful of hospitals to implement a liaison service for elderly surgical patients we have seen both quantitative and qualitative improvements in the care delivered. Both co-ordination and continuity of care has improved and overall staff feel that the service forms an integral part of caring for the older surgical patient. Currently only 1% of UK hospitals are meeting targets for implementation of liaison services for their elderly surgical patients. Our surgical liaison service offers consultant led care for older people and is valued amongst users. We would like to share our experiences in the service setup, provision and its subsequent impact on patient care.
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16
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Richards SJG, D’Souza J, Pascoe R, Falloon M, Frizelle FA. Prevalence of frailty in a tertiary hospital: A point prevalence observational study. PLoS One 2019; 14:e0219083. [PMID: 31260483 PMCID: PMC6602419 DOI: 10.1371/journal.pone.0219083] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/15/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Frailty is an important concept in modern healthcare due to its association with adverse outcomes. Its prevalence varies in the literature and there is a paucity of literature looking at the prevalence of frailty in an inpatient setting. Its significance lies on its impact on resource utilisation and costs. AIM To determine the prevalence of frailty in the adult population in a tertiary New Zealand hospital. METHODS Eligible patients aged 18 years and over were invited to participate, and frailty assessment was performed using the Reported Edmonton Frail Scale. A score of 8 or more was considered frail. Factors associated with frailty were assessed. RESULTS Of 640 occupied inpatient beds, 420 patients were assessed. 220 patients were excluded, of which 89 were absent from their bed-space, 73 declined and 41 were critically unwell. The overall prevalence of frailty across assessed patients was 48.8%. The prevalence of frailty increased significantly with age; patients aged 85 and over were significantly more likely to be frail compared to those aged under 65 (OR 6.25, 95% CI 3.17-12.7). Maori patients were significantly more likely to be frail (OR 4.0, 95% CI 1.45-11.9). When compared to those patients admitted to a medical specialty, patients admitted to surgical specialty were less likely to be frail (OR 0.52 95% CI 0.31-0.86) and those admitted for rehabilitation were more likely to be frail (OR 1.86 95% CI 1.03-3.41). Frail patients were more likely to come from a rest home (OR 2.81, 95% CI 1.38-6.14) or hospital level care (OR 9.62, 95% CI 2.68-61.6). CONCLUSION Frailty is highly prevalent in the hospital setting with 48.8% of all inpatients classified as frail. This high number of frail patients has significant resource implications and an increased understanding of the burden of frailty in this population may aid targeting of interventions towards this vulnerable population.
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Affiliation(s)
| | - Joel D’Souza
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Rebecca Pascoe
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Michelle Falloon
- Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Frank A. Frizelle
- Department of Surgery, University of Otago, Christchurch, New Zealand
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