Shipra Arya1, Chandler A Long2, Reshma Brahmbhatt2, Susan Shafii2, Luke P Brewster3, Ravi Veeraswamy2, Theodore M Johnson4, Jason M Johanning5. 1. Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Surgical Service Line, Atlanta VA Medical Center, Decatur, GA. Electronic address: shipra.arya@emory.edu. 2. Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA. 3. Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Surgical Service Line, Atlanta VA Medical Center, Decatur, GA. 4. Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine. 5. Division of Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
Abstract
BACKGROUND: Patient-centered quality outcomes such as disposition after surgery are increasingly being scrutinized. Preoperative factors predictive of nonhome discharge (DC) may identify at-risk patients for targeted interventions. This study examines the association among preoperative risk factors, frailty, and nonhome DC after elective vascular surgery procedures in patients living at home. METHODS: The 2011-2012 National Surgical Quality Improvement Project database was queried to identify all home-dwelling patients who underwent elective vascular procedures (endovascular and open aortic aneurysm repair, suprainguinal and infrainguinal bypasses, peripheral endovascular interventions, carotid endarterectomy, and stent). Preoperative frailty was measured using the modified frailty index (mFI; derived from Canadian Study of Health and Aging). Univariate and multivariate logistic regression analysis was performed to examine the association of frailty and nonhome DC. RESULTS: Of 15,843 home-dwelling patients, 1,177 patients (7.4%) did not return home postoperatively. Frailty (mFI > 0.25) conferred a significantly increased 2-fold risk of nonhome DC disposition for each procedure type. Frailty, female gender, open procedures, increasing age, end-stage renal disease, and occurrence of any postoperative complication were associated with increased risk of nonhome DC. On multivariate logistic regression analysis, frailty increased the odds of nonhome DC by 60% (odds ratio 1.6, 95% confidence interval 1.4-1.8) after adjusting for other covariates. In the presence of complications, the risk of nonhome DC was 27.5% in frail versus 16.5% in nonfrail patients (P < 0.001). In the absence of complications, although absolute risk was lower, frail patients were nearly twice as likely to not return home (frail 5.5% vs. nonfrail 2.75%, P < 0.001). CONCLUSIONS: Frail home-dwelling patients undergoing elective vascular procedures are at high risk of not returning home after surgery. Preoperative frailty assessment appears to hold potential for counseling regarding postsurgery disposition and DC planning. Published by Elsevier Inc.
BACKGROUND:Patient-centered quality outcomes such as disposition after surgery are increasingly being scrutinized. Preoperative factors predictive of nonhome discharge (DC) may identify at-risk patients for targeted interventions. This study examines the association among preoperative risk factors, frailty, and nonhome DC after elective vascular surgery procedures in patients living at home. METHODS: The 2011-2012 National Surgical Quality Improvement Project database was queried to identify all home-dwelling patients who underwent elective vascular procedures (endovascular and open aortic aneurysm repair, suprainguinal and infrainguinal bypasses, peripheral endovascular interventions, carotid endarterectomy, and stent). Preoperative frailty was measured using the modified frailty index (mFI; derived from Canadian Study of Health and Aging). Univariate and multivariate logistic regression analysis was performed to examine the association of frailty and nonhome DC. RESULTS: Of 15,843 home-dwelling patients, 1,177 patients (7.4%) did not return home postoperatively. Frailty (mFI > 0.25) conferred a significantly increased 2-fold risk of nonhome DC disposition for each procedure type. Frailty, female gender, open procedures, increasing age, end-stage renal disease, and occurrence of any postoperative complication were associated with increased risk of nonhome DC. On multivariate logistic regression analysis, frailty increased the odds of nonhome DC by 60% (odds ratio 1.6, 95% confidence interval 1.4-1.8) after adjusting for other covariates. In the presence of complications, the risk of nonhome DC was 27.5% in frail versus 16.5% in nonfrail patients (P < 0.001). In the absence of complications, although absolute risk was lower, frail patients were nearly twice as likely to not return home (frail 5.5% vs. nonfrail 2.75%, P < 0.001). CONCLUSIONS: Frail home-dwelling patients undergoing elective vascular procedures are at high risk of not returning home after surgery. Preoperative frailty assessment appears to hold potential for counseling regarding postsurgery disposition and DC planning. Published by Elsevier Inc.
Authors: A C Panayi; A R Orkaby; D Sakthivel; Y Endo; D Varon; D Roh; D P Orgill; R L Neppl; H Javedan; S Bhasin; I Sinha Journal: Am J Surg Date: 2018-11-27 Impact factor: 2.565
Authors: Kara A Rothenberg; Elizabeth L George; Amber W Trickey; Nicolas B Barreto; Theodore M Johnson; Daniel E Hall; Jason M Johanning; Shipra Arya Journal: Ann Vasc Surg Date: 2020-01-11 Impact factor: 1.466
Authors: Elizabeth L George; Rui Chen; Amber W Trickey; Benjamin S Brooke; Larry Kraiss; Matthew W Mell; Philip P Goodney; Jason Johanning; Jason Hockenberry; Shipra Arya Journal: J Vasc Surg Date: 2019-05-27 Impact factor: 4.268
Authors: Natalie D Sridharan; Rabih A Chaer; Bryan Boyuan Wu; Mohammad H Eslami; Michel S Makaroun; Efthymios D Avgerinos Journal: Ann Vasc Surg Date: 2017-07-06 Impact factor: 1.466
Authors: Elizabeth L George; Nader N Massarweh; Ada Youk; Katherine M Reitz; Myrick C Shinall; Rui Chen; Amber W Trickey; Patrick R Varley; Jason Johanning; Paula K Shireman; Shipra Arya; Daniel E Hall Journal: JAMA Surg Date: 2022-03-01 Impact factor: 14.766
Authors: Danielle C Sutzko; Elizabeth A Andraska; Andrew A Gonzalez; Apurba K Chakrabarti; Nicholas H Osborne Journal: J Surg Res Date: 2018-04-14 Impact factor: 2.192