Y. Li1, J. L. Pederson1, T. A. Churchill1, A. S. Wagg2,5, J. S. Holroyd-Leduc3,5, K. Alagiakrishnan2,5, R. S. Padwal2,6, R. G. Khadaroo1,4 1University Of Alberta,Department Of Surgery,Edmonton, AB, Canada 2University Of Alberta,Department Of Medicine,Edmonton, AB, Canada 3University Of Calgary,Department Of Medicine And Community Health Sciences,Calgary, AB, Canada 4University Of Alberta,Department Of Critical Care Medicine,Edmonton, AB, Canada 5Alberta Seniors Health Strategic Clinical Network,Calgary, AB, Canada 6Alberta Diabetes Institute,Edmonton, AB, Canada
Introduction:
Frailty is a subjective measure of decreased physiological reserve across multiple organ systems. Hospital readmissions are costly and may reflect quality of care, yet the importance of frailty for prognosis after discharge following emergency surgery is not well established. We evaluated the association of frailty and risk of readmission or post-discharge death in older surgical patients.
Methods:
We prospectively followed patients aged ≥ 65 years admitted to Acute Care Surgery at two tertiary care centres in Alberta, Canada who preoperatively required assistance with <3 activities of daily living. Severity of frailty prior to admission was defined as well (score ≤ 2), managing-vulnerable (3-4), and mildly-moderately frail (≥ 5) on the CSHA Clinical Frailty Scale (CFS). Primary endpoints were composites 30-day and 6-month all-cause readmission or death. We assessed endpoints using multivariable logistic regression that adjusted for confounders (Table 1).
Results:
Of 308 patients included, the mean age was 76±7.6 years, 55% were female, and the median CFS was 3 (range 1-6); 168 patients were managing-vulnerable and 68 were mildly-moderately frail. Most surgeries performed were cholecystectomies/appendectomies (28% closed, 8% open), small intestine (28%) or colon surgery (14%), and hernia repairs (14%). At 30 days, 42 (13.6%) and at 6 months, 104 (33.8%) patients were readmitted or died. Frail patients were more likely to be readmitted or have died within 30 days: 16% of managing-vulnerable (adjusted odds ratio [aOR] 4.60, 95% CI 1.29-16.45, p=0.019) and 18% of mildly-moderately frail (aOR 4.51, 95% CI 1.13-17.94, p=0.033) compared to 4% of well patients. At 6 months, an independent dose-response relationship was observed for increasing frailty severity: 33% of patients managing-vulnerable (aOR 2.15, 95% CI 1.01-4.55, p=0.046) and 54% of those mildly-moderately frail (aOR 3.27, 95% CI 1.31-8.12, p=0.011) were readmitted or died compared to 15% of well patients.
Conclusion:
Patients undergoing emergency abdominal surgery who were more frail were also more likely to be readmitted to hospital at 30 days and 6 months. To our knowledge, this is the first study to assess the impact of frailty on adverse events after discharge in this population. These findings can assist in developing targeted interventions to prevent readmissions in this vulnerable population.
