For moderate-risk surgeries, 5.1% of frail patients and 18.7% of very frail patients died within 30 days. Mortality continued to rise for frail patients as time went on. The highest mortality rate recorded in the study was for very frail patients 180 days after moderate-risk surgery. About 43% of those patients had died.
Frailty rating remained a significant predictor of mortality regardless of the number of complications a patient had.
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The results show that frailty adds significant risk to surgery, say the researchers, even when the surgery is considered minor.
Surgeons often do not consider whether patients can endure the stress of surgery for low-risk procedures, according to the researchers. Based on the results, the researchers recommend that patients be assessed using the RAI before any type of surgical procedure. If frailty is shown to be a risk, they say, surgeons could focus on pre-operative interventions to address it.
Assessing frailty could also help doctors and patients decide whether surgery is the best treatment option. As the researchers write in their report, "Even minor operations are high-risk for frail patients; surgeons and referring physicians should consider if the potential benefits of surgery warrant the increased risk."
Dr. Daniel Hall, the corresponding author on the paper, is leading efforts to spread preoperative frailty screening in VA. The practice has been implemented in several VA medical centers already. Hall, a researcher at the VA Pittsburgh Healthcare System and the University of Pittsburgh, recently took part in a "Shark Tank" event held by VA's Diffusion of Excellence program. The VHA Shark Tank Competition offers VA employees the opportunities to share practices that address clinical and operational priorities to improve the veteran care experience. Through the competition, Hall received bids to implement the frailty screening at several more VA sites, earning Hall's practice the honor of "Gold Status."
The study was funded by VA Health Services Research and Development.Back to HCB News