Perioperative medicine & outcomes
Association of Routine Preoperative Frailty Assessment With 1-Year Postoperative Mortality
Authors' conclusion
This quality improvement study found that implementation of an RAI-based FSI was associated with increased referrals of frail patients for enhanced presurgical evaluation. These referrals translated to a survival advantage among frail patients of similar magnitude to those observed in a Veterans Affairs health care setting
Study context
- Population
- Patients considering elective surgery in a multihospital, integrated US health care system, with at least 1 year of postsurgical follow-up
- Participants
- 50,463 patients
- Exposure
- After vs before implementation of a frailty screening initiative
- Before interventionn = 22,722reference
- Aftern = 27,741
- Outcome
- Mortality after the elective surgical procedure
- Follow-up
- 365 days
Methodological detailslongitudinal cohort, multihospital integrated health care system
- Longitudinal cohort
- Multihospital integrated health care system
Main finding
As reported in the abstract
After vs before Best Practice Alert (BPA) implementation, multivariable regression: 18% reduction in odds of 1-year mortality
0.82; 95% CI, 0.72-0.92; P < .001 (OR; 95% CI; P)
Interrupted time series: significant slope change in 365-day mortality rate, preintervention vs postintervention
0.12% to −0.04%
Observational data: associations, not effects.
Secondary outcomes
Referral of frail patients to primary care physician
Referral of frail patients to presurgical care clinic
- Referral of frail patients to primary care physician: P < .001
- Referral of frail patients to presurgical care clinic: P < .001
1-year mortality among patients triggering the BPA (subgroup)
- Estimated change in 1-year mortality among patients triggering the BPA
- −4.2% (95% CI, −6.0% to −2.4%) (95% CI)
Original publication
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