Association of Frailty with Failure to Rescue After Low-Risk and High-Risk Inpatient Surgery.

JAMA Surg. doi:10.1001/jamasurg.2018.0214

Presented by: Dr Steve Young

Background

This is a retrospective data set study from American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). It investigated the role of frailty in post operative outcomes

Design & Setting

It used the above data set from 2005-2012. It looked at patients in the data, assessed their frailty using the Risk Analysis Index and then compared their outcomes along with type of procedure (low risk or high risk)

Subjects

  • In patients undergoing general, vascular, cardiac, thoracic and orthopaedic operations 2005-2012 at 600 hospitals in the United States.
  • Final analysed data set just under 1 million patients.

Intervention

This was an observational study

Outcomes   

Complication rates after inpatient surgery

Results

Increasing frailty increases your rate of complications

Conclusions

Preoperative patient frailty is an important risk factor for post operative complications

Strengths

  • Very large comprehensive data set.
  • Statistically significant outcomes
  • Clinically significant outcomes
  • Relevant to our practice

Weaknesses

  • Retrospective observational study
  • No intervention
  • The outcome is pretty obvious

Implications

Although probably a useful study to confirm obviousness, I’m not sure how much this adds to my practice

Potential for impact

As above, I am not sure this adds much but it does confirm what we thought.