Faculty Collaboration Database

A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surg Endosc 2017 Jun;31(6):2509-2519

Date

10/05/2016

Pubmed ID

27699515

Pubmed Central ID

PMC5378684

DOI

10.1007/s00464-016-5253-7

Scopus ID

2-s2.0-84989957487 (requires institutional sign-in at Scopus site)   141 Citations

Abstract

BACKGROUND: Frailty is a measure of physiologic reserve associated with increased vulnerability to adverse outcomes following surgery in older adults. The 'accumulating deficits' model of frailty has been applied to the NSQIP database, and an 11-item modified frailty index (mFI) has been validated. We developed a condensed 5-item frailty index and used this to assess the relationship between frailty and outcomes in patients undergoing paraesophageal hernia (PEH) repair.

METHODS: The NSQIP database was queried for ICD-9 and CPT codes associated with PEH repair. Subjects ≥60 years who underwent PEH repair between 2011 and 2013 were included. Five of the 11 mFI items present in the NSQIP data on the most consistent basis were selected for the condensed index. Univariate and multivariate logistic regressions were used to determine the validity of the 5-item mFI as a predictor of postoperative mortality, complications, readmission, and non-routine discharge.

RESULTS: A total of 3711 patients had data for all variables in the 5-item index, while 885 patients had complete data to calculate the 11-item mFI. After controlling for competing risk factors, including age, ASA score, wound classification, surgical approach, and procedure timing (emergent vs non-emergent), we found the 5-item mFI remained predictive of 30-day mortality and patients being discharged to a location other than home (p < 0.05). A weighted Kappa was calculated to assess agreement between the 5-item and 11-item mFI and was found to be 0.8709 (p < 0.001).

CONCLUSIONS: Frailty, as assessed by the 5-item mFI, is a reasonable alternative to the 11-item mFI in patients undergoing PEH repair. Utilization of the 5-item mFI allows for a significantly increased sample size compared to the 11-item mFI. Further study is necessary to determine whether the condensed 5-item mFI is a valid measure to assess frailty for other types of surgery.

Author List

Chimukangara M, Helm MC, Frelich MJ, Bosler ME, Rein LE, Szabo A, Gould JC

Authors

Jon Gould MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Lisa E. Rein Biostatistician III in the Institute for Health and Equity department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Databases, Factual
Female
Frail Elderly
Frailty
Geriatric Assessment
Hernia, Hiatal
Herniorrhaphy
Humans
International Classification of Diseases
Logistic Models
Male
Middle Aged
Patient Discharge
Postoperative Complications
Retrospective Studies
Risk Factors
Severity of Illness Index