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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Article info
Publication history
Published online: April 25, 2022
Accepted:
March 15,
2022
Footnotes
Priya Pathak and Kota Sahara contributed equally to this work.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
