Association of Routine Preoperative Frailty Assessment With 1-Year Postoperative Mortality

作者：Patrick R. Varley, Dan Buchanan, Andrew L. Bilderback, Mary Kay Wisniewski, Jason Michael Johanning, Joel B. Nelson, Jonas Talmadge Johnson, Tamra E. Minnier, Daniel E. Hall · 发表于：JAMA Surgery · 年份：2023 · DOI：10.1001/jamasurg.2022.8341 · 被引用次数：82 · 研究领域：Frailty in Older Adults、Cardiac, Anesthesia and Surgical Outcomes、Nutrition and Health in Aging

Importance: Patient frailty is a known risk factor for adverse outcomes following surgery, but data are limited regarding whether systemwide interventions related to frailty are associated with improved patient outcomes. Objective: To evaluate whether a frailty screening initiative (FSI) is associated with reduced late-term mortality after elective surgery. Design, Setting, and Participants: This quality improvement study with an interrupted time series analysis used data from a longitudinal cohort of patients in a multihospital, integrated health care system in the US. Beginning in July 2016, surgeons were incentivized to measure frailty with the Risk Analysis Index (RAI) for all patients considering elective surgery. Implementation of the BPA occurred in February 2018. The cutoff for data collection was May 31, 2019. Analyses were conducted between January and September 2022. Exposures: The exposure of interest was an Epic Best Practice Alert (BPA) used to identify patients with frailty (RAI ≥42) and prompt surgeons to document a frailty-informed shared decision-making process and consider additional evaluation by a multidisciplinary presurgical care clinic or the primary care physician. Main Outcomes and Measures: The primary outcome was 365-day mortality after the elective surgical procedure. Secondary outcomes included 30-day and 180-day mortality as well as the proportion of patients referred for additional evaluation based on documented frailty. Results: A total of 50 ...