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JAMA Surg. 2017 Aug 1;152(8):749-757. doi: 10.1001/jamasurg.2017.1025.

Association of the Modified Frailty Index With 30-Day Surgical Readmission.

Author information

1
Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.
2
Department of Surgery, University of Alabama at Birmingham.
3
Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California.
4
Department of Surgery, Stanford University, Stanford, California.
5
Veterans Affairs Central Western Massachusetts Health Care System, Leeds.
6
Center for Applied Health Research, Baylor Scott & White Health, Temple, Texas.
7
Department of Medicine, Texas A&M Health Science Center, Temple.
8
Department of Surgery, Milwaukee Veterans Affairs Medical Center, Milwaukee, Wisconsin.
9
Department of Medicine, Medical College of Wisconsin, Milwaukee.
10
Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
11
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
12
School of Medicine, Harvard University, Boston, Massachusetts.

Abstract

Importance:

Frail patients are known to have poor perioperative outcomes. There is a paucity of literature investigating how the Modified Frailty Index (mFI), a validated measure of frailty, is associated with unplanned readmission among military veterans following surgery.

Objective:

To understand the association between frailty and 30-day postoperative unplanned readmission.

Design, Setting, and Participants:

A retrospective cohort study was conducted among adult patients who underwent surgery and were discharged alive from Veterans Affairs hospitals for orthopedic, general, and vascular conditions between October 1, 2007, and September 30, 2014, with a postoperative length of stay between 2 and 30 days.

Exposure:

Frailty, as calculated by the 11 variables on the mFI.

Main Outcomes and Measures:

The primary outcome of interest is 30-day unplanned readmission. Secondary outcomes included any 30-day predischarge or postdischarge complication, 30-day postdischarge mortality, and 30-day emergency department visit.

Results:

The study sample included 236 957 surgical procedures (among 223 877 men and 13 080 women; mean [SD] age, 64.0 [11.3] years) from high-volume surgical specialties: 101 348 procedures (42.8%) in orthopedic surgery, 92 808 procedures (39.2%) in general surgery, and 42 801 procedures (18.1%) in vascular surgery. The mFI was associated with readmission (odds ratio [OR], 1.11; 95% CI, 1.10-1.12; R2 = 10.3%; C statistic, 0.71). Unadjusted rates of overall 30-day readmission (26 262 [11.1%]), postdischarge emergency department visit (34 204 [14.4%]), any predischarge (13 855 [5.9%]) or postdischarge (14 836 [6.3%]) complication, and postdischarge mortality (1985 [0.8%]) varied by frailty in a dose-dependent fashion. In analysis by individual mFI components using Harrell ranking, impaired functional status, identified as nonindependent functional status (OR, 1.16; 95% CI, 1.11-1.21; P < .01) or having a residual deficit from a prior cerebrovascular accident (OR, 1.17; 95% CI, 1.11-1.22; P < .01), contributed most to the ability of the mFI to anticipate readmission compared with the other components. Acutely impaired sensorium (OR, 1.12; 95% CI, 0.99-1.27; P = .08) and history of a myocardial infarction within 6 months (OR, 0.93; 95% CI, 0.81-1.06; P = .28) were not significantly associated with readmission.

Conclusions and Relevance:

The mFI is associated with poor surgical outcomes, including readmission, primarily due to impaired functional status. Targeting potentially modifiable aspects of frailty preoperatively, such as improving functional status, may improve perioperative outcomes and decrease readmissions.

PMID:
28467535
PMCID:
PMC5710500
DOI:
10.1001/jamasurg.2017.1025
[Indexed for MEDLINE]
Free PMC Article

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