Perioperative medicine & outcomes
Domains of Frailty Predict Loss of Independence in Older Adults After Noncardiac Surgery
Main finding · LOIResult — go to the resultOdds ratio 1.37 95% CI 1.30–1.45Authors' conclusion
Among domains measured by the EFS before a wide range of noncardiac surgeries in older adults, functional performance, functional dependence, social support, and urinary incontinence were independently associated with and improved the prediction of LOI.
Study context
- Population
- Patients aged ≥65 living independently, evaluated with the Edmonton Frail Scale (EFS) at a preoperative visit (Center for Preoperative Optimization, Johns Hopkins Hospital, June 2018–January 2020), before noncardiac surgeryanalysed
- Participants
- 3,497 patients
- Exposure
- Impairment in individual EFS domains and total EFS score as predictors of loss of independence (LOI)
- Outcome
- LOI: discharge to increased level of care outside the home with new mobility deficit or functional dependence
Methodological detailssingle-centre
- Single-centre
Main finding
LOI
Odds ratio
1.37
95% CI 1.30–1.45
P < 0.001
Total EFS score
OR 1.37 (95% CI 1.30–1.45); P < 0.001
As reported in the abstract
- Patients experiencing LOI
- 235/3497 (6.7%)
- Cross-validation: total EFS improved LOI prediction, final model AUC
- 0.840
- Functional performance was the single domain most improving prediction; with functional dependence, social support and urinary incontinence, model AUC
- 0.838
Observational data: associations, not effects.
Further findings
Frailty and EFS domain impairment frequencies
- Median total EFS score (range 0-16)
- 3
- Frail (EFS≥6)
- 725/3497 (27%)
- Functional performance moderately impaired
- 33.5%
- Functional performance severely impaired
- 11%
- History of hospital readmission
- 42%
- Poor self-described health status
- 37%
- Cognition moderately impaired
- 17.1%
- Cognition severely impaired
- 13.8%
Original publication
Domains of Frailty Predict Loss of Independence in Older Adults After Noncardiac Surgery. Ann Surg. Published 20 September 2022. doi:10.
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