Abstract

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.To understand the association between frailty and 30-day postoperative unplanned readmission.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.Frailty, as calculated by the 11 variables on the mFI.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.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?

View details for DOI 10.1001/jamasurg.2017.1025

View details for PubMedID 28467535