Han Ting Wang1, François Martin Carrier2, Anne Tremblay3, Marie-Maude Joly3, Rafik Ghali4, George Heckman5,6, John P Hirdes6, Paul Hebert7. 1. Division of Internal and Critical Care Medicine, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 boul. L'Assomption, Montreal, QC, Canada. ht.wang85@gmail.com. 2. Department of Anesthesia and Department of Medicine, Critical Care Division, Centre hospitalier de l'Université de Montréal, Department of Anesthesiology and Pain Medicine, Université de Montréal, Centre de recherche du CHUM, Montreal, QC, Canada. 3. Division of Internal Medicine, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, QC, Canada. 4. Division of Vascular Surgery, Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, QC, Canada. 5. Schlegel Research Institute of Aging and School, Waterloo, ON, Canada. 6. School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada. 7. Department de Medicine, Université de Montréal et Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Abstract
PURPOSE: Identifying patients at risk of postoperative complications and trying to prevent these complications are the essence of preoperative evaluation. While not overtly frail or disabled, vulnerable patients with mild frailty may be missed by routine assessments and may still have a worse postoperative course. METHODS: We performed a prospective cohort study evaluating vulnerability in older patients undergoing elective surgery. Vulnerability was assessed using the Clinical Frailty Scale. Our primary outcome was postoperative hospital length of stay (LOS) and our secondary outcome was non-home hospital discharge. We performed multivariable analyses to assess the association between vulnerability and our primary and secondary outcome. RESULTS: Between 1 January 2017 and 1 January 2018, 271 older patients with a median [interquartile range (IQR)] age of 72 [69-76] yr underwent frailty assessment prior to surgery. Eighty-eight (32.5%) of the cohort were classified as vulnerable. The median [IQR] duration of hospital LOS was 4 [2-7] days for vulnerable patients, 4 [2-6] days for robust patients, and 7 [3-10] days for frail patients. After adjusting for confounders, hospital LOS was not longer for vulnerable patients than for robust patients, but was associated with a higher rate of non-home discharge (odds ratio, 3.7; 95% confidence interval, 1.1 to 12.9; P = 0.04). CONCLUSIONS: Vulnerability was not associated with a longer hospital LOS but with higher risk of non-home discharge. Vulnerable patients might benefit from early identification and advanced planning with earlier transfer to rehabilitation centres.
PURPOSE: Identifying patients at risk of postoperative complications and trying to prevent these complications are the essence of preoperative evaluation. While not overtly frail or disabled, vulnerable patients with mild frailty may be missed by routine assessments and may still have a worse postoperative course. METHODS: We performed a prospective cohort study evaluating vulnerability in older patients undergoing elective surgery. Vulnerability was assessed using the Clinical Frailty Scale. Our primary outcome was postoperative hospital length of stay (LOS) and our secondary outcome was non-home hospital discharge. We performed multivariable analyses to assess the association between vulnerability and our primary and secondary outcome. RESULTS: Between 1 January 2017 and 1 January 2018, 271 older patients with a median [interquartile range (IQR)] age of 72 [69-76] yr underwent frailty assessment prior to surgery. Eighty-eight (32.5%) of the cohort were classified as vulnerable. The median [IQR] duration of hospital LOS was 4 [2-7] days for vulnerable patients, 4 [2-6] days for robust patients, and 7 [3-10] days for frail patients. After adjusting for confounders, hospital LOS was not longer for vulnerable patients than for robust patients, but was associated with a higher rate of non-home discharge (odds ratio, 3.7; 95% confidence interval, 1.1 to 12.9; P = 0.04). CONCLUSIONS: Vulnerability was not associated with a longer hospital LOS but with higher risk of non-home discharge. Vulnerable patients might benefit from early identification and advanced planning with earlier transfer to rehabilitation centres.