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Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients.
Ann Vasc Surg. 2016 Aug; 35:19-29.AV

Abstract

BACKGROUND

Patient-centered quality outcomes such as disposition after surgery are increasingly being scrutinized. Preoperative factors predictive of nonhome discharge (DC) may identify at-risk patients for targeted interventions. This study examines the association among preoperative risk factors, frailty, and nonhome DC after elective vascular surgery procedures in patients living at home.

METHODS

The 2011-2012 National Surgical Quality Improvement Project database was queried to identify all home-dwelling patients who underwent elective vascular procedures (endovascular and open aortic aneurysm repair, suprainguinal and infrainguinal bypasses, peripheral endovascular interventions, carotid endarterectomy, and stent). Preoperative frailty was measured using the modified frailty index (mFI; derived from Canadian Study of Health and Aging). Univariate and multivariate logistic regression analysis was performed to examine the association of frailty and nonhome DC.

RESULTS

Of 15,843 home-dwelling patients, 1,177 patients (7.4%) did not return home postoperatively. Frailty (mFI > 0.25) conferred a significantly increased 2-fold risk of nonhome DC disposition for each procedure type. Frailty, female gender, open procedures, increasing age, end-stage renal disease, and occurrence of any postoperative complication were associated with increased risk of nonhome DC. On multivariate logistic regression analysis, frailty increased the odds of nonhome DC by 60% (odds ratio 1.6, 95% confidence interval 1.4-1.8) after adjusting for other covariates. In the presence of complications, the risk of nonhome DC was 27.5% in frail versus 16.5% in nonfrail patients (P < 0.001). In the absence of complications, although absolute risk was lower, frail patients were nearly twice as likely to not return home (frail 5.5% vs. nonfrail 2.75%, P < 0.001).

CONCLUSIONS

Frail home-dwelling patients undergoing elective vascular procedures are at high risk of not returning home after surgery. Preoperative frailty assessment appears to hold potential for counseling regarding postsurgery disposition and DC planning.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Surgical Service Line, Atlanta VA Medical Center, Decatur, GA. Electronic address: shipra.arya@emory.edu.Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Surgical Service Line, Atlanta VA Medical Center, Decatur, GA.Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine.Division of Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27263810

Citation

Arya, Shipra, et al. "Preoperative Frailty Increases Risk of Nonhome Discharge After Elective Vascular Surgery in Home-Dwelling Patients." Annals of Vascular Surgery, vol. 35, 2016, pp. 19-29.
Arya S, Long CA, Brahmbhatt R, et al. Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients. Ann Vasc Surg. 2016;35:19-29.
Arya, S., Long, C. A., Brahmbhatt, R., Shafii, S., Brewster, L. P., Veeraswamy, R., Johnson, T. M., & Johanning, J. M. (2016). Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients. Annals of Vascular Surgery, 35, 19-29. https://doi.org/10.1016/j.avsg.2016.01.052
Arya S, et al. Preoperative Frailty Increases Risk of Nonhome Discharge After Elective Vascular Surgery in Home-Dwelling Patients. Ann Vasc Surg. 2016;35:19-29. PubMed PMID: 27263810.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients. AU - Arya,Shipra, AU - Long,Chandler A, AU - Brahmbhatt,Reshma, AU - Shafii,Susan, AU - Brewster,Luke P, AU - Veeraswamy,Ravi, AU - Johnson,Theodore M,2nd AU - Johanning,Jason M, Y1 - 2016/06/02/ PY - 2015/04/19/received PY - 2016/01/18/revised PY - 2016/01/22/accepted PY - 2016/6/7/entrez PY - 2016/6/7/pubmed PY - 2017/1/24/medline SP - 19 EP - 29 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 35 N2 - BACKGROUND: Patient-centered quality outcomes such as disposition after surgery are increasingly being scrutinized. Preoperative factors predictive of nonhome discharge (DC) may identify at-risk patients for targeted interventions. This study examines the association among preoperative risk factors, frailty, and nonhome DC after elective vascular surgery procedures in patients living at home. METHODS: The 2011-2012 National Surgical Quality Improvement Project database was queried to identify all home-dwelling patients who underwent elective vascular procedures (endovascular and open aortic aneurysm repair, suprainguinal and infrainguinal bypasses, peripheral endovascular interventions, carotid endarterectomy, and stent). Preoperative frailty was measured using the modified frailty index (mFI; derived from Canadian Study of Health and Aging). Univariate and multivariate logistic regression analysis was performed to examine the association of frailty and nonhome DC. RESULTS: Of 15,843 home-dwelling patients, 1,177 patients (7.4%) did not return home postoperatively. Frailty (mFI > 0.25) conferred a significantly increased 2-fold risk of nonhome DC disposition for each procedure type. Frailty, female gender, open procedures, increasing age, end-stage renal disease, and occurrence of any postoperative complication were associated with increased risk of nonhome DC. On multivariate logistic regression analysis, frailty increased the odds of nonhome DC by 60% (odds ratio 1.6, 95% confidence interval 1.4-1.8) after adjusting for other covariates. In the presence of complications, the risk of nonhome DC was 27.5% in frail versus 16.5% in nonfrail patients (P < 0.001). In the absence of complications, although absolute risk was lower, frail patients were nearly twice as likely to not return home (frail 5.5% vs. nonfrail 2.75%, P < 0.001). CONCLUSIONS: Frail home-dwelling patients undergoing elective vascular procedures are at high risk of not returning home after surgery. Preoperative frailty assessment appears to hold potential for counseling regarding postsurgery disposition and DC planning. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/27263810/Preoperative_Frailty_Increases_Risk_of_Nonhome_Discharge_after_Elective_Vascular_Surgery_in_Home_Dwelling_Patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(16)30397-1 DB - PRIME DP - Unbound Medicine ER -