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Development and validation of risk stratification tool for prediction of increased dependence using preoperative frailty after hepatopancreatic surgery

  • Priya Pathak
    Affiliations
    Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH

    Pancreatic Multidisciplinary Clinic, Johns Hopkins Sydney Kimmel Comprehensive Cancer Center, MD
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  • Kota Sahara
    Affiliations
    Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH

    Department of Gastrointestinal Surgery, Yokohama City University School of Medicine, Yokohama, Japan
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  • Gaya Spolverato
    Affiliations
    Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Italy
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  • Timothy M. Pawlik
    Correspondence
    Reprint requests: Timothy M. Pawlik, MD, MPH, PhD, Professor and Chair, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH 43210.
    Affiliations
    Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH
    Search for articles by this author
Published:April 25, 2022DOI:https://doi.org/10.1016/j.surg.2022.03.021

      Abstract

      Background

      Despite the known association between frailty and postoperative morbidity, the use of preoperative frailty in surgical practice remains limited. We sought to develop a risk tool to predict postoperative increase in functional dependence.

      Methods

      Patients of ≥65 years in the National Surgical Quality Improvement Project database who had a primary hepatopancreatic surgery between 2015 and 2019 were used to identify predictors of increased dependence and development of a simplified tool to calculate the risk stratification score for increased discharge care level (https://ktsahara.shinyapps.io/care_discharge/).

      Results

      Among 31,338 patients who underwent primary hepatopancreatic surgery, 4,259 (13.6%) had an increased level of care at discharge compared to their preadmission care. Patients with increased discharge care had a higher proportion of patients with a modified frailty index of at least 2 (n = 1496; 35.1%) compared with individuals with unchanged care (n = 6,760; 25.0%). In addition, 12.3% (n = 3,858) were discharged to a skilled nursing or rehabilitation facility. Of note, the odds of increased care at discharge were increased by 1.41 (95% confidence interval: 1.32–1.50), 1.11 (95% confidence interval :1.11–1.12), and 1.95 (95% confidence interval:1.86–2.04) times with every unit increase in modified frailty index, age beyond 65 years, and the number of in-hospital complications, respectively. Area under receiver operative curve for the parsimonious model used to develop the risk calculator was 0.7486 (95% confidence interval: 0.7405–0.7566) (all P < .001).

      Conclusion

      Approximately, 1 in 7 patients required an increased level of care at the time of discharge compared with their preadmission status. A simplified web-based risk tool can be used in clinical practice as a surgical decision aid in post-discharge planning after complex elective surgery.
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