Brett M Tracy1, Jacob M Wilson2, Randi N Smith3, Mara L Schenker4, Rondi B Gelbard3. 1. Department of Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: brett.m.tracy@emory.edu. 2. Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, Georgia. 3. Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; Division of Trauma & Surgical Critical Care, Grady Memorial Hospital, Atlanta, Georgia. 4. Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, Georgia; Division of Trauma & Surgical Critical Care, Grady Memorial Hospital, Atlanta, Georgia.
Abstract
BACKGROUND: The 5-item modified frailty index (mFI-5) has been shown to predict adverse outcomes in surgery; yet, its role in trauma patients is unclear. We hypothesized that increasing frailty, as indicated by increasing mFI-5 scores, would correlate with worse outcomes and greater mortality in trauma patients. METHODS: We performed a retrospective review of patients captured by our 2018 Spring and Fall Trauma Quality Improvement Program registry. The mFI-5 was calculated by assigning one point for each comorbidity present: diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functionally dependent health status. Outcomes included complications, length of stay, mortality, and discharge location. RESULTS: A total of 3364 patients were included; 68.0% (n = 2288) were not frail, 16.5% (n = 555) were moderately frail, and 15.5% (n = 521) were severely frail. Higher frailty scores were associated with greater rates of unplanned intubations (P < 0.01) and unplanned admissions to the intensive care unit (P < 0.01). Rates of nonhome discharge (P < 0.0001) were significantly higher in the severe frailty group compared with the moderate and no frailty groups. On multivariable regression adjusting for demographics and injury details, severe frailty was predictive of any complication (odds ratio [OR], 1.53; 95% confidence interval [95% CI], 1.12-2.11; P < 0.01), failure to rescue (OR, 2.88; 95% CI, 1.47-5.66; P = 0.002), nonhome discharge (OR, 1.88; 95% CI, 1.47-2.40; P < 0.0001), and mortality (OR, 1.83; 95% CI, 1.07-3.15; P = 0.03). CONCLUSIONS: Frailty is not only associated with longer hospitalizations but also with more complications, adverse discharge locations, and increased odds of mortality. The mFI-5 is a quick and intuitive tool that can be used to determine an individual's frailty at the time of admission.
BACKGROUND: The 5-item modified frailty index (mFI-5) has been shown to predict adverse outcomes in surgery; yet, its role in traumapatients is unclear. We hypothesized that increasing frailty, as indicated by increasing mFI-5 scores, would correlate with worse outcomes and greater mortality in traumapatients. METHODS: We performed a retrospective review of patients captured by our 2018 Spring and Fall Trauma Quality Improvement Program registry. The mFI-5 was calculated by assigning one point for each comorbidity present: diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functionally dependent health status. Outcomes included complications, length of stay, mortality, and discharge location. RESULTS: A total of 3364 patients were included; 68.0% (n = 2288) were not frail, 16.5% (n = 555) were moderately frail, and 15.5% (n = 521) were severely frail. Higher frailty scores were associated with greater rates of unplanned intubations (P < 0.01) and unplanned admissions to the intensive care unit (P < 0.01). Rates of nonhome discharge (P < 0.0001) were significantly higher in the severe frailty group compared with the moderate and no frailty groups. On multivariable regression adjusting for demographics and injury details, severe frailty was predictive of any complication (odds ratio [OR], 1.53; 95% confidence interval [95% CI], 1.12-2.11; P < 0.01), failure to rescue (OR, 2.88; 95% CI, 1.47-5.66; P = 0.002), nonhome discharge (OR, 1.88; 95% CI, 1.47-2.40; P < 0.0001), and mortality (OR, 1.83; 95% CI, 1.07-3.15; P = 0.03). CONCLUSIONS: Frailty is not only associated with longer hospitalizations but also with more complications, adverse discharge locations, and increased odds of mortality. The mFI-5 is a quick and intuitive tool that can be used to determine an individual's frailty at the time of admission.