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A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair.
Surg Endosc. 2017 06; 31(6):2509-2519.SE

Abstract

BACKGROUND

Frailty is a measure of physiologic reserve associated with increased vulnerability to adverse outcomes following surgery in older adults. The 'accumulating deficits' model of frailty has been applied to the NSQIP database, and an 11-item modified frailty index (mFI) has been validated. We developed a condensed 5-item frailty index and used this to assess the relationship between frailty and outcomes in patients undergoing paraesophageal hernia (PEH) repair.

METHODS

The NSQIP database was queried for ICD-9 and CPT codes associated with PEH repair. Subjects ≥60 years who underwent PEH repair between 2011 and 2013 were included. Five of the 11 mFI items present in the NSQIP data on the most consistent basis were selected for the condensed index. Univariate and multivariate logistic regressions were used to determine the validity of the 5-item mFI as a predictor of postoperative mortality, complications, readmission, and non-routine discharge.

RESULTS

A total of 3711 patients had data for all variables in the 5-item index, while 885 patients had complete data to calculate the 11-item mFI. After controlling for competing risk factors, including age, ASA score, wound classification, surgical approach, and procedure timing (emergent vs non-emergent), we found the 5-item mFI remained predictive of 30-day mortality and patients being discharged to a location other than home (p < 0.05). A weighted Kappa was calculated to assess agreement between the 5-item and 11-item mFI and was found to be 0.8709 (p < 0.001).

CONCLUSIONS

Frailty, as assessed by the 5-item mFI, is a reasonable alternative to the 11-item mFI in patients undergoing PEH repair. Utilization of the 5-item mFI allows for a significantly increased sample size compared to the 11-item mFI. Further study is necessary to determine whether the condensed 5-item mFI is a valid measure to assess frailty for other types of surgery.

Authors+Show Affiliations

Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.Department of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA. jgould@mcw.edu.

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

27699515

Citation

Chimukangara, Munyaradzi, et al. "A 5-item Frailty Index Based On NSQIP Data Correlates With Outcomes Following Paraesophageal Hernia Repair." Surgical Endoscopy, vol. 31, no. 6, 2017, pp. 2509-2519.
Chimukangara M, Helm MC, Frelich MJ, et al. A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surg Endosc. 2017;31(6):2509-2519.
Chimukangara, M., Helm, M. C., Frelich, M. J., Bosler, M. E., Rein, L. E., Szabo, A., & Gould, J. C. (2017). A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surgical Endoscopy, 31(6), 2509-2519. https://doi.org/10.1007/s00464-016-5253-7
Chimukangara M, et al. A 5-item Frailty Index Based On NSQIP Data Correlates With Outcomes Following Paraesophageal Hernia Repair. Surg Endosc. 2017;31(6):2509-2519. PubMed PMID: 27699515.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. AU - Chimukangara,Munyaradzi, AU - Helm,Melissa C, AU - Frelich,Matthew J, AU - Bosler,Matthew E, AU - Rein,Lisa E, AU - Szabo,Aniko, AU - Gould,Jon C, Y1 - 2016/10/03/ PY - 2016/03/16/received PY - 2016/09/13/accepted PY - 2016/10/5/pubmed PY - 2018/1/31/medline PY - 2016/10/5/entrez KW - Frailty KW - Geriatric KW - NSQIP KW - Outcomes KW - Paraesophageal hernia SP - 2509 EP - 2519 JF - Surgical endoscopy JO - Surg Endosc VL - 31 IS - 6 N2 - BACKGROUND: Frailty is a measure of physiologic reserve associated with increased vulnerability to adverse outcomes following surgery in older adults. The 'accumulating deficits' model of frailty has been applied to the NSQIP database, and an 11-item modified frailty index (mFI) has been validated. We developed a condensed 5-item frailty index and used this to assess the relationship between frailty and outcomes in patients undergoing paraesophageal hernia (PEH) repair. METHODS: The NSQIP database was queried for ICD-9 and CPT codes associated with PEH repair. Subjects ≥60 years who underwent PEH repair between 2011 and 2013 were included. Five of the 11 mFI items present in the NSQIP data on the most consistent basis were selected for the condensed index. Univariate and multivariate logistic regressions were used to determine the validity of the 5-item mFI as a predictor of postoperative mortality, complications, readmission, and non-routine discharge. RESULTS: A total of 3711 patients had data for all variables in the 5-item index, while 885 patients had complete data to calculate the 11-item mFI. After controlling for competing risk factors, including age, ASA score, wound classification, surgical approach, and procedure timing (emergent vs non-emergent), we found the 5-item mFI remained predictive of 30-day mortality and patients being discharged to a location other than home (p < 0.05). A weighted Kappa was calculated to assess agreement between the 5-item and 11-item mFI and was found to be 0.8709 (p < 0.001). CONCLUSIONS: Frailty, as assessed by the 5-item mFI, is a reasonable alternative to the 11-item mFI in patients undergoing PEH repair. Utilization of the 5-item mFI allows for a significantly increased sample size compared to the 11-item mFI. Further study is necessary to determine whether the condensed 5-item mFI is a valid measure to assess frailty for other types of surgery. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/27699515/A_5_item_frailty_index_based_on_NSQIP_data_correlates_with_outcomes_following_paraesophageal_hernia_repair_ L2 - https://doi.org/10.1007/s00464-016-5253-7 DB - PRIME DP - Unbound Medicine ER -