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Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States

BACKGROUND: Frailty has been recognized as an independent risk factor for inferior outcomes, but its effect on emergency general surgery (EGS) is understudied. OBJECTIVE: The purpose of the present study was to define the impact of frailty on risk-adjusted mortality, non-home discharge, and readmiss...

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Autores principales: Hadaya, Joseph, Sanaiha, Yas, Juillard, Catherine, Benharash, Peyman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301636/
https://www.ncbi.nlm.nih.gov/pubmed/34297772
http://dx.doi.org/10.1371/journal.pone.0255122
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author Hadaya, Joseph
Sanaiha, Yas
Juillard, Catherine
Benharash, Peyman
author_facet Hadaya, Joseph
Sanaiha, Yas
Juillard, Catherine
Benharash, Peyman
author_sort Hadaya, Joseph
collection PubMed
description BACKGROUND: Frailty has been recognized as an independent risk factor for inferior outcomes, but its effect on emergency general surgery (EGS) is understudied. OBJECTIVE: The purpose of the present study was to define the impact of frailty on risk-adjusted mortality, non-home discharge, and readmission following EGS operations. METHODS: Adults undergoing appendectomy, cholecystectomy, small bowel resection, large bowel resection, repair of perforated ulcer, or laparotomy within two days of an urgent admission were identified in the 2016–2017 Nationwide Readmissions Database. Frailty was defined using diagnosis codes corresponding to the Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable regression was used to study in-hospital mortality and non-home discharge by operation, and Kaplan Meier analysis to study freedom from unplanned readmission at up to 90-days follow-up. RESULTS: Among 655,817 patients, 11.9% were considered frail. Frail patients most commonly underwent large bowel resection (37.3%) and cholecystectomy (29.2%). After adjustment, frail patients had higher mortality rates for all operations compared to nonfrail, including those most commonly performed (11.9% [95% CI 11.4–12.5%] vs 6.0% [95% CI 5.8–6.3%] for large bowel resection; 2.3% [95% CI 2.0–2.6%] vs 0.2% [95% CI 0.2–0.2%] for cholecystectomy). Adjusted non-home discharge rates were higher for frail compared to nonfrail patients following all operations, including large bowel resection (68.1% [95% CI 67.1–69.0%] vs 25.9% [95% CI 25.2–26.5%]) and cholecystectomy (33.7% [95% CI 32.7–34.7%] vs 2.9% [95% CI 2.8–3.0%]). Adjusted hospitalization costs were nearly twice as high for frail patients. On Kaplan-Meier analysis, frail patients had greater unplanned readmissions (log rank P<0.001), with 1 in 4 rehospitalized within 90 days. CONCLUSIONS: Frail patients have inferior clinical outcomes and greater resource use following EGS, with the greatest absolute differences following complex operations. Simple frailty assessments may inform expectations, identify patients at risk of poor outcomes, and guide the need for more intensive postoperative care.
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spelling pubmed-83016362021-07-31 Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States Hadaya, Joseph Sanaiha, Yas Juillard, Catherine Benharash, Peyman PLoS One Research Article BACKGROUND: Frailty has been recognized as an independent risk factor for inferior outcomes, but its effect on emergency general surgery (EGS) is understudied. OBJECTIVE: The purpose of the present study was to define the impact of frailty on risk-adjusted mortality, non-home discharge, and readmission following EGS operations. METHODS: Adults undergoing appendectomy, cholecystectomy, small bowel resection, large bowel resection, repair of perforated ulcer, or laparotomy within two days of an urgent admission were identified in the 2016–2017 Nationwide Readmissions Database. Frailty was defined using diagnosis codes corresponding to the Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable regression was used to study in-hospital mortality and non-home discharge by operation, and Kaplan Meier analysis to study freedom from unplanned readmission at up to 90-days follow-up. RESULTS: Among 655,817 patients, 11.9% were considered frail. Frail patients most commonly underwent large bowel resection (37.3%) and cholecystectomy (29.2%). After adjustment, frail patients had higher mortality rates for all operations compared to nonfrail, including those most commonly performed (11.9% [95% CI 11.4–12.5%] vs 6.0% [95% CI 5.8–6.3%] for large bowel resection; 2.3% [95% CI 2.0–2.6%] vs 0.2% [95% CI 0.2–0.2%] for cholecystectomy). Adjusted non-home discharge rates were higher for frail compared to nonfrail patients following all operations, including large bowel resection (68.1% [95% CI 67.1–69.0%] vs 25.9% [95% CI 25.2–26.5%]) and cholecystectomy (33.7% [95% CI 32.7–34.7%] vs 2.9% [95% CI 2.8–3.0%]). Adjusted hospitalization costs were nearly twice as high for frail patients. On Kaplan-Meier analysis, frail patients had greater unplanned readmissions (log rank P<0.001), with 1 in 4 rehospitalized within 90 days. CONCLUSIONS: Frail patients have inferior clinical outcomes and greater resource use following EGS, with the greatest absolute differences following complex operations. Simple frailty assessments may inform expectations, identify patients at risk of poor outcomes, and guide the need for more intensive postoperative care. Public Library of Science 2021-07-23 /pmc/articles/PMC8301636/ /pubmed/34297772 http://dx.doi.org/10.1371/journal.pone.0255122 Text en © 2021 Hadaya et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Hadaya, Joseph
Sanaiha, Yas
Juillard, Catherine
Benharash, Peyman
Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States
title Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States
title_full Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States
title_fullStr Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States
title_full_unstemmed Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States
title_short Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States
title_sort impact of frailty on clinical outcomes and resource use following emergency general surgery in the united states
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301636/
https://www.ncbi.nlm.nih.gov/pubmed/34297772
http://dx.doi.org/10.1371/journal.pone.0255122
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