Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States.

<h4>Background</h4>Frailty has been recognized as an independent risk factor for inferior outcomes, but its effect on emergency general surgery (EGS) is understudied.<h4>Objective</h4>The purpose of the present study was to define the impact of frailty on risk-adjusted mortal...

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Autores principales:	Joseph Hadaya, Yas Sanaiha, Catherine Juillard, Peyman Benharash
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/54e732bcf3874302b1bbaa44d46e92d7
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spelling	oai:doaj.org-article:54e732bcf3874302b1bbaa44d46e92d72021-12-02T20:06:29ZImpact of frailty on clinical outcomes and resource use following emergency general surgery in the United States.1932-620310.1371/journal.pone.0255122https://doaj.org/article/54e732bcf3874302b1bbaa44d46e92d72021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255122https://doaj.org/toc/1932-6203<h4>Background</h4>Frailty has been recognized as an independent risk factor for inferior outcomes, but its effect on emergency general surgery (EGS) is understudied.<h4>Objective</h4>The purpose of the present study was to define the impact of frailty on risk-adjusted mortality, non-home discharge, and readmission following EGS operations.<h4>Methods</h4>Adults undergoing appendectomy, cholecystectomy, small bowel resection, large bowel resection, repair of perforated ulcer, or laparotomy within two days of an urgent admission were identified in the 2016-2017 Nationwide Readmissions Database. Frailty was defined using diagnosis codes corresponding to the Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable regression was used to study in-hospital mortality and non-home discharge by operation, and Kaplan Meier analysis to study freedom from unplanned readmission at up to 90-days follow-up.<h4>Results</h4>Among 655,817 patients, 11.9% were considered frail. Frail patients most commonly underwent large bowel resection (37.3%) and cholecystectomy (29.2%). After adjustment, frail patients had higher mortality rates for all operations compared to nonfrail, including those most commonly performed (11.9% [95% CI 11.4-12.5%] vs 6.0% [95% CI 5.8-6.3%] for large bowel resection; 2.3% [95% CI 2.0-2.6%] vs 0.2% [95% CI 0.2-0.2%] for cholecystectomy). Adjusted non-home discharge rates were higher for frail compared to nonfrail patients following all operations, including large bowel resection (68.1% [95% CI 67.1-69.0%] vs 25.9% [95% CI 25.2-26.5%]) and cholecystectomy (33.7% [95% CI 32.7-34.7%] vs 2.9% [95% CI 2.8-3.0%]). Adjusted hospitalization costs were nearly twice as high for frail patients. On Kaplan-Meier analysis, frail patients had greater unplanned readmissions (log rank P<0.001), with 1 in 4 rehospitalized within 90 days.<h4>Conclusions</h4>Frail patients have inferior clinical outcomes and greater resource use following EGS, with the greatest absolute differences following complex operations. Simple frailty assessments may inform expectations, identify patients at risk of poor outcomes, and guide the need for more intensive postoperative care.Joseph HadayaYas SanaihaCatherine JuillardPeyman BenharashPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0255122 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Joseph Hadaya Yas Sanaiha Catherine Juillard Peyman Benharash Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States.
description	<h4>Background</h4>Frailty has been recognized as an independent risk factor for inferior outcomes, but its effect on emergency general surgery (EGS) is understudied.<h4>Objective</h4>The purpose of the present study was to define the impact of frailty on risk-adjusted mortality, non-home discharge, and readmission following EGS operations.<h4>Methods</h4>Adults undergoing appendectomy, cholecystectomy, small bowel resection, large bowel resection, repair of perforated ulcer, or laparotomy within two days of an urgent admission were identified in the 2016-2017 Nationwide Readmissions Database. Frailty was defined using diagnosis codes corresponding to the Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable regression was used to study in-hospital mortality and non-home discharge by operation, and Kaplan Meier analysis to study freedom from unplanned readmission at up to 90-days follow-up.<h4>Results</h4>Among 655,817 patients, 11.9% were considered frail. Frail patients most commonly underwent large bowel resection (37.3%) and cholecystectomy (29.2%). After adjustment, frail patients had higher mortality rates for all operations compared to nonfrail, including those most commonly performed (11.9% [95% CI 11.4-12.5%] vs 6.0% [95% CI 5.8-6.3%] for large bowel resection; 2.3% [95% CI 2.0-2.6%] vs 0.2% [95% CI 0.2-0.2%] for cholecystectomy). Adjusted non-home discharge rates were higher for frail compared to nonfrail patients following all operations, including large bowel resection (68.1% [95% CI 67.1-69.0%] vs 25.9% [95% CI 25.2-26.5%]) and cholecystectomy (33.7% [95% CI 32.7-34.7%] vs 2.9% [95% CI 2.8-3.0%]). Adjusted hospitalization costs were nearly twice as high for frail patients. On Kaplan-Meier analysis, frail patients had greater unplanned readmissions (log rank P<0.001), with 1 in 4 rehospitalized within 90 days.<h4>Conclusions</h4>Frail patients have inferior clinical outcomes and greater resource use following EGS, with the greatest absolute differences following complex operations. Simple frailty assessments may inform expectations, identify patients at risk of poor outcomes, and guide the need for more intensive postoperative care.
format	article
author	Joseph Hadaya Yas Sanaiha Catherine Juillard Peyman Benharash
author_facet	Joseph Hadaya Yas Sanaiha Catherine Juillard Peyman Benharash
author_sort	Joseph Hadaya
title	Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States.
title_short	Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States.
title_full	Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States.
title_fullStr	Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States.
title_full_unstemmed	Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States.
title_sort	impact of frailty on clinical outcomes and resource use following emergency general surgery in the united states.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/54e732bcf3874302b1bbaa44d46e92d7
work_keys_str_mv	AT josephhadaya impactoffrailtyonclinicaloutcomesandresourceusefollowingemergencygeneralsurgeryintheunitedstates AT yassanaiha impactoffrailtyonclinicaloutcomesandresourceusefollowingemergencygeneralsurgeryintheunitedstates AT catherinejuillard impactoffrailtyonclinicaloutcomesandresourceusefollowingemergencygeneralsurgeryintheunitedstates AT peymanbenharash impactoffrailtyonclinicaloutcomesandresourceusefollowingemergencygeneralsurgeryintheunitedstates
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Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States.

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