A ground-breaking cohort study conducted at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, has unveiled a strong association between frailty status and postoperative adverse events in patients recovering from major noncardiac surgery. The research, published in a recent medical journal, utilized an automated electronic frailty index (eFI) to categorize patients as fit, prefrail, or frail, shedding light on the significant impact of frailty on postoperative outcomes.
The Study’s Key Findings:
In this comprehensive study of 33,449 patients who underwent noncardiac surgeries lasting at least one hour, patients classified as prefrail or frail demonstrated higher odds of experiencing postoperative adverse events when compared to their fit counterparts. Each 0.03-unit increase in the eFI score corresponded to a higher risk of postoperative complications.
These findings emphasize the critical role frailty status plays in determining the likelihood of postoperative adverse events, especially in older adults undergoing noncardiac surgery. The deployment of eFI tools could provide essential support for screening and potentially modifying risks in high-risk surgical cases.
The eFI Tool: An Automated Approach to Measuring Frailty
The eFI, or electronic frailty index, is an innovative automated tool integrated within electronic health records (EHRs). It relies on various data sources, such as clinical encounters, diagnosis codes, laboratory results, medications, and Medicare annual wellness visits, to determine a patient’s frailty status.
The eFI, updated weekly for patients aged 55 and older, quantifies frailty by assessing a patient’s health-related deficits, making it a valuable tool for identifying patients at risk of adverse outcomes.
Study Design and Patient Cohort:
This cohort study was conducted at a prominent tertiary care academic medical center in North Carolina. It included patients aged 55 and older who underwent noncardiac surgeries lasting at least one hour between October 1, 2017, and June 30, 2021.
Patients were categorized into three frailty groups based on their eFI scores: fit, prefrail, or frail. The study then analyzed a range of adverse events, including in-hospital mortality, 30-day mortality, 30-day readmission, transfer to skilled nursing facilities, and unexpected intensive care unit admissions, among others.
Key Takeaways:
The study confirmed that patients classified as prefrail and frail were at a significantly higher risk of postoperative adverse events compared to fit patients. Even after accounting for various confounding factors and comorbidity burden, the association between frailty status and adverse outcomes remained robust.
Importantly, when the eFI score was treated as a continuous variable, it revealed a direct correlation between the degree of frailty and the risk of postoperative adverse events. Each 0.03-unit increase in the eFI score corresponded to an elevated risk.
The study highlights the importance of frailty assessment in preoperative evaluations, as it can help identify patients at risk of postoperative complications and guide preoperative interventions to reduce these risks.
This research serves as a significant step toward enhancing patient care and surgical planning, especially for high-risk surgeries, by harnessing the power of automated electronic frailty index tools.