C. A. Powell1, G. Y. Kim1, M. Goldman2, N. Alexander3, L. Min3, M. Mathis4, P. Grossman5, N. M. Duggal4, A. Sales6, M. A. Corriere1 1University Of Michigan, Department Of Surgery, Section Of Vascular Surgery, Ann Arbor, MI, USA 2Wake Forest University School Of Medicine, Department Of Vascular And Endovascular Surgery, Winston-Salem, NC, USA 3University Of Michigan, Department Of Internal Medicine, Division Of Geriatric And Palliative Medicine, Ann Arbor, MI, USA 4University Of Michigan, Department Of Anesthesiology, Ann Arbor, MI, USA 5University Of Michigan, Department Of Internal Medicine, Division Of Cardiovascular Medicine, Ann Arbor, MI, USA 6University Of Michigan, Department Of Learning Health Sciences, Ann Arbor, MI, USA
Introduction: Comorbidity-based risk adjustment is often applied retrospectively, limiting potential to influence treatment selection or decrease perioperative risk. Weakness (or low grip strength) is associated with decreased survival, increased morbidity, and sarcopenia among patients with vascular disease. Prevalence of categorical weakness is 25-30% among patients with vascular disease, but whether screening leads to recognition or documentation of this diagnosis is unknown. We implemented grip strength screening in outpatient cardiovascular specialist clinics and compared coding prevalence of age-related physical debility between patients evaluated with grip strength measurement versus not.
Methods: Grip strength measurement was implemented in select outpatient cardiovascular clinics at a single location within an academic healthcare system in May 2019. Grip strength was measured in kilograms during pre-rooming check-in using hydraulic hand dynamometers, recorded in kilograms, and recorded as a discrete data element within the electronic medical record (EMR) . An EMR system smartphrase supported clinician interpretation and documentation, with functionality to import grip strength values into progress notes alongside a table permitting categorization of patients as weak or not based on gender and body mass index (Figure 1). Patients undergoing major vascular operations post-implementation were identified based on general anesthesia in combination with aortic, carotid, extremity, mesenteric, or renal arterial procedures or extremity amputation. Prevalence of grip strength measurement was tracked using EMR reports and compared to frailty diagnosis based on ICD-10-CM code R54 (age-related physical debility). Associations between grip strength measurement and coding were evaluated using logistic regression.
Results: 1590 patients were identified who underwent major vascular operations during the study period from May 2019- August 2021, of whom grip strength measurement was obtained from 403 (25.4%). Prevalence of ICD-10-CM R54 was 1.8% overall, and was significantly greater among patients screened with grip strength (4.0%) versus not (1.1%) [OR 3.7; 95% CI (1.8-7.8); P<0.0005].
Conclusion: Grip strength screening was associated with increased clinician coding of age-related physical debility among patients undergoing major vascular operations, although coding prevalence remained well below population prevalence of categorical weakness. Future research will explore influences of grip strength measurement and related categorization of patients as weak and/or frail versus not on treatment selection and outcomes, and implementation strategies to further increase clinician awareness and integration into treatment selection.
