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The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population.
Surg J (N Y). 2018 Apr; 4(2):e66-e77.SJ

Abstract

Background The burden of frail patients undergoing emergency general surgery (EGS) is increasing rapidly and this population is particularly susceptible to postoperative cardiopulmonary complications and mortality. We aimed to determine the association between frailty, as defined by the previously described modified frailty index (mFI), and postoperative respiratory complications (unplanned reintubation, pneumonia, and prolonged ventilation), cardiac complications (myocardial infarction and cardiac arrest), and mortality. We also sought to identify the most significant determinants of frailty in the highest risk patients based on the specific variables comprising the mFI. Methods We performed a retrospective observational analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database. Files from 2005 to 2015 identified 132,765 inpatients who underwent EGS. mFI scores were calculated for each patient. The effect of increasing frailty on unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality was evaluated using bivariate analysis. Multivariable logistic regression was used to compare mFI with additional predictor variables including race, gender, physical status as defined by the American Society of Anesthesiologists, disseminated cancer, renal failure, smoking status, sepsis, wound presence/classification, dyspnea, and previous ventilator dependence. Results Unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality were significantly associated with frailty, and the odds of each postoperative complication increased with increasing mFI score. Of the frailest patients (mFI ≥3) that experienced cardiopulmonary complications or mortality, the variables of the mFI that contributed most to frailty were hypertension requiring medication and functional status before surgery. Conclusions A higher mFI score is associated with increased odds of postoperative cardiopulmonary complications and mortality in the EGS population. Specific variables of the mFI can also provide valuable information for assessing odds in the frailest patients undergoing EGS.

Authors+Show Affiliations

Department of Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, New Jersey.Department of Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, New Jersey.Department of Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, New Jersey.Department of Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, New Jersey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29796424

Citation

Akyar, Serra, et al. "The Impact of Frailty On Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population." Surgery Journal (New York, N.Y.), vol. 4, no. 2, 2018, pp. e66-e77.
Akyar S, Armenia SJ, Ratnani P, et al. The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population. Surg J (N Y). 2018;4(2):e66-e77.
Akyar, S., Armenia, S. J., Ratnani, P., & Merchant, A. M. (2018). The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population. Surgery Journal (New York, N.Y.), 4(2), e66-e77. https://doi.org/10.1055/s-0038-1655756
Akyar S, et al. The Impact of Frailty On Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population. Surg J (N Y). 2018;4(2):e66-e77. PubMed PMID: 29796424.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population. AU - Akyar,Serra, AU - Armenia,Sarah J, AU - Ratnani,Parita, AU - Merchant,Aziz M, Y1 - 2018/05/23/ PY - 2018/01/23/received PY - 2018/04/10/accepted PY - 2018/5/26/entrez PY - 2018/5/26/pubmed PY - 2018/5/26/medline KW - emergency general surgery KW - frailty KW - postoperative complications KW - risk factors KW - surgical outcomes SP - e66 EP - e77 JF - Surgery journal (New York, N.Y.) JO - Surg J (N Y) VL - 4 IS - 2 N2 - Background The burden of frail patients undergoing emergency general surgery (EGS) is increasing rapidly and this population is particularly susceptible to postoperative cardiopulmonary complications and mortality. We aimed to determine the association between frailty, as defined by the previously described modified frailty index (mFI), and postoperative respiratory complications (unplanned reintubation, pneumonia, and prolonged ventilation), cardiac complications (myocardial infarction and cardiac arrest), and mortality. We also sought to identify the most significant determinants of frailty in the highest risk patients based on the specific variables comprising the mFI. Methods We performed a retrospective observational analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database. Files from 2005 to 2015 identified 132,765 inpatients who underwent EGS. mFI scores were calculated for each patient. The effect of increasing frailty on unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality was evaluated using bivariate analysis. Multivariable logistic regression was used to compare mFI with additional predictor variables including race, gender, physical status as defined by the American Society of Anesthesiologists, disseminated cancer, renal failure, smoking status, sepsis, wound presence/classification, dyspnea, and previous ventilator dependence. Results Unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality were significantly associated with frailty, and the odds of each postoperative complication increased with increasing mFI score. Of the frailest patients (mFI ≥3) that experienced cardiopulmonary complications or mortality, the variables of the mFI that contributed most to frailty were hypertension requiring medication and functional status before surgery. Conclusions A higher mFI score is associated with increased odds of postoperative cardiopulmonary complications and mortality in the EGS population. Specific variables of the mFI can also provide valuable information for assessing odds in the frailest patients undergoing EGS. SN - 2378-5128 UR - https://www.unboundmedicine.com/medline/citation/29796424/The_Impact_of_Frailty_on_Postoperative_Cardiopulmonary_Complications_in_the_Emergency_General_Surgery_Population_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0038-1655756 DB - PRIME DP - Unbound Medicine ER -
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