Qi Yan1, Jeongsoo Kim, Daniel E Hall, Myrick C Shinall, Katherine Moll Reitz, Karyn B Stitzenberg, Lillian S Kao, Elizabeth L George, Ada Youk, Chen-Pin Wang, Jonathan C Silverstein, Elmer V Bernstam, Paula K Shireman. 1. Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas South Texas Veterans Health Care System, San Antonio, Texas University Health, San Antonio, Texas Center for Health Equity Research and Promotion, and Geriatric Research Education and Clinical Care Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania Wolff Center, UPMC, Pittsburgh, Pennsylvania Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Department of Surgery, University of North Carolina, Chapel Hill, North Carolina Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas Department of Surgery, Stanford University School of Medicine, Stanford, California. Division of Health Services Research and Development, VA Palo Alto Healthcare System, Palo Alto, California Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania School of Biomedical Informatics, The University of Texas Health Science Center at Houston, TX, United States Division of General Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, United States.
Abstract
OBJECTIVE: Expand Operative Stress Score (OSS) increasing procedural coverage and assessing OSS and frailty association with Preoperative Acute Serious Conditions (PASC), complications and mortality in females versus males. SUMMARY BACKGROUND DATA: Veterans Affairs male-dominated study showed high mortality in frail veterans even after very low stress surgeries (OSS1). METHODS: Retrospective cohort using NSQIP data (2013-2019) merged with 180-day postoperative mortality from multiple hospitals to evaluate PASC, 30-day complications and 30-, 90- and 180-day mortality. RESULTS: OSS expansion resulted in 98.2% case coverage versus 87.0% using the original. Of 82,269 patients (43.8% male), 7.9% were frail/very frail. Males had higher odds of PASC (aOR = 1.31, 95%CI = 1.21-1.41, P < .001) and severe/life-threatening Clavien-Dindo IV (CDIV) complications (aOR = 1.18, 95%CI = 1.09-1.28, P < .001). While mortality rates were higher (all time points, P < .001) in males versus females, mortality was similar after adjusting for frailty, OSS, and case status primarily due to increased male frailty scores. Additional adjustments for PASC and CDIV resulted in a lower odds of mortality in males (30-day, aOR = 0.81, CI = 0.71-0.92, P = .002) that was most pronounced for males with PASC compared to females with PASC (30-day, aOR = 0.75, CI = 0.56-0.99, P = .04). CONCLUSIONS: Similar to the male-dominated Veteran population, private sector, frail patients have high likelihood of postoperative mortality, even after low stress surgeries. Preoperative frailty screening should be performed regardless of magnitude of the procedure. Despite males experiencing higher adjusted odds of PASC and CDIV complications, females with PASC had higher odds of mortality compared to males, suggesting differences in the aggressiveness of care provided to men and women.
OBJECTIVE: Expand Operative Stress Score (OSS) increasing procedural coverage and assessing OSS and frailty association with Preoperative Acute Serious Conditions (PASC), complications and mortality in females versus males. SUMMARY BACKGROUND DATA: Veterans Affairs male-dominated study showed high mortality in frail veterans even after very low stress surgeries (OSS1). METHODS: Retrospective cohort using NSQIP data (2013-2019) merged with 180-day postoperative mortality from multiple hospitals to evaluate PASC, 30-day complications and 30-, 90- and 180-day mortality. RESULTS: OSS expansion resulted in 98.2% case coverage versus 87.0% using the original. Of 82,269 patients (43.8% male), 7.9% were frail/very frail. Males had higher odds of PASC (aOR = 1.31, 95%CI = 1.21-1.41, P < .001) and severe/life-threatening Clavien-Dindo IV (CDIV) complications (aOR = 1.18, 95%CI = 1.09-1.28, P < .001). While mortality rates were higher (all time points, P < .001) in males versus females, mortality was similar after adjusting for frailty, OSS, and case status primarily due to increased male frailty scores. Additional adjustments for PASC and CDIV resulted in a lower odds of mortality in males (30-day, aOR = 0.81, CI = 0.71-0.92, P = .002) that was most pronounced for males with PASC compared to females with PASC (30-day, aOR = 0.75, CI = 0.56-0.99, P = .04). CONCLUSIONS: Similar to the male-dominated Veteran population, private sector, frail patients have high likelihood of postoperative mortality, even after low stress surgeries. Preoperative frailty screening should be performed regardless of magnitude of the procedure. Despite males experiencing higher adjusted odds of PASC and CDIV complications, females with PASC had higher odds of mortality compared to males, suggesting differences in the aggressiveness of care provided to men and women.
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