Failure to rescue after emergency general surgery in geriatric patients: does frailty matter?

Muhammad Khan, Faisal Jehan, Muhammad Zeeshan, Narong Kulvatunyou, Mindy J Fain, Abdul Tawab Saljuqi, Terence S Okeeffe, Bellal A Joseph

Research output: Contribution to journalArticle

Abstract

Background: Failure to rescue (FTR) is considered as an index of quality of care provided by a hospital. However, the role of frailty in FTR remains unclear. We hypothesized that the FTR rate is higher for frail geriatric emergency general surgery (EGS) patients than nonfrail geriatric EGS patients. Methods: We performed a 3-y (2015-2017) prospective cohort study of all geriatric patients (age ≥ 65 y) requiring EGS. Frailty was calculated by using the EGS-specific Frailty Index (EGSFI) within 24 h of admission. Patients were divided into two groups: frail (FI ≥ 0.325) and nonfrail (FI < 0.325). We defined FTR as death from a major complication. Regression analysis was performed to control for demographics, type of operative intervention, admission vitals, and admission laboratory values. Results: Three hundred twenty-six geriatric EGS patients were included, of which 38.9% were frail. Frail patients were more likely to be white (P < 0.01) and, on admission, had a higher American Association of Anesthesiologist class (P = 0.03) and lower serum albumin (P < 0.01). However, there was no difference between the groups regarding age (P = 0.54), gender (P = 0.56), admission vitals, and WBC count (P = 0.35). Overall, 26.7% (n = 85) of patients developed in-hospital complications; and mortality occurred in 30% (n = 26) of those patients (i.e., the FTR group). Frail patients had higher rates of FTR (14% vs. 4%, P < 0.001) than nonfrail patients. On regression analysis, after controlling for confounders, frail status was an independent predictor of FTR (OR: 3.4 [2.3-4.6]) in geriatric EGS patients. Conclusions: Our study demonstrates that in geriatric EGS patients, a frail status independently contributes to FTR and increases the odds of FTR threefold compared with nonfrail status. Thus, it should be included in quality metrics for geriatric EGS patients.

LanguageEnglish (US)
Pages397-402
Number of pages6
JournalJournal of Surgical Research
Volume233
DOIs
StatePublished - Jan 1 2019

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Geriatrics
Emergencies
Regression Analysis
Quality of Health Care
Serum Albumin
Cohort Studies
Age Groups
Demography
Prospective Studies

Keywords

  • EGS
  • Failure to rescue
  • Frailty
  • FTR

ASJC Scopus subject areas

  • Surgery

Cite this

Failure to rescue after emergency general surgery in geriatric patients : does frailty matter? / Khan, Muhammad; Jehan, Faisal; Zeeshan, Muhammad; Kulvatunyou, Narong; Fain, Mindy J; Saljuqi, Abdul Tawab; Okeeffe, Terence S; Joseph, Bellal A.

In: Journal of Surgical Research, Vol. 233, 01.01.2019, p. 397-402.

Research output: Contribution to journalArticle

Khan, Muhammad ; Jehan, Faisal ; Zeeshan, Muhammad ; Kulvatunyou, Narong ; Fain, Mindy J ; Saljuqi, Abdul Tawab ; Okeeffe, Terence S ; Joseph, Bellal A. / Failure to rescue after emergency general surgery in geriatric patients : does frailty matter?. In: Journal of Surgical Research. 2019 ; Vol. 233. pp. 397-402.
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abstract = "Background: Failure to rescue (FTR) is considered as an index of quality of care provided by a hospital. However, the role of frailty in FTR remains unclear. We hypothesized that the FTR rate is higher for frail geriatric emergency general surgery (EGS) patients than nonfrail geriatric EGS patients. Methods: We performed a 3-y (2015-2017) prospective cohort study of all geriatric patients (age ≥ 65 y) requiring EGS. Frailty was calculated by using the EGS-specific Frailty Index (EGSFI) within 24 h of admission. Patients were divided into two groups: frail (FI ≥ 0.325) and nonfrail (FI < 0.325). We defined FTR as death from a major complication. Regression analysis was performed to control for demographics, type of operative intervention, admission vitals, and admission laboratory values. Results: Three hundred twenty-six geriatric EGS patients were included, of which 38.9{\%} were frail. Frail patients were more likely to be white (P < 0.01) and, on admission, had a higher American Association of Anesthesiologist class (P = 0.03) and lower serum albumin (P < 0.01). However, there was no difference between the groups regarding age (P = 0.54), gender (P = 0.56), admission vitals, and WBC count (P = 0.35). Overall, 26.7{\%} (n = 85) of patients developed in-hospital complications; and mortality occurred in 30{\%} (n = 26) of those patients (i.e., the FTR group). Frail patients had higher rates of FTR (14{\%} vs. 4{\%}, P < 0.001) than nonfrail patients. On regression analysis, after controlling for confounders, frail status was an independent predictor of FTR (OR: 3.4 [2.3-4.6]) in geriatric EGS patients. Conclusions: Our study demonstrates that in geriatric EGS patients, a frail status independently contributes to FTR and increases the odds of FTR threefold compared with nonfrail status. Thus, it should be included in quality metrics for geriatric EGS patients.",
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AU - Khan, Muhammad

AU - Jehan, Faisal

AU - Zeeshan, Muhammad

AU - Kulvatunyou, Narong

AU - Fain, Mindy J

AU - Saljuqi, Abdul Tawab

AU - Okeeffe, Terence S

AU - Joseph, Bellal A

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N2 - Background: Failure to rescue (FTR) is considered as an index of quality of care provided by a hospital. However, the role of frailty in FTR remains unclear. We hypothesized that the FTR rate is higher for frail geriatric emergency general surgery (EGS) patients than nonfrail geriatric EGS patients. Methods: We performed a 3-y (2015-2017) prospective cohort study of all geriatric patients (age ≥ 65 y) requiring EGS. Frailty was calculated by using the EGS-specific Frailty Index (EGSFI) within 24 h of admission. Patients were divided into two groups: frail (FI ≥ 0.325) and nonfrail (FI < 0.325). We defined FTR as death from a major complication. Regression analysis was performed to control for demographics, type of operative intervention, admission vitals, and admission laboratory values. Results: Three hundred twenty-six geriatric EGS patients were included, of which 38.9% were frail. Frail patients were more likely to be white (P < 0.01) and, on admission, had a higher American Association of Anesthesiologist class (P = 0.03) and lower serum albumin (P < 0.01). However, there was no difference between the groups regarding age (P = 0.54), gender (P = 0.56), admission vitals, and WBC count (P = 0.35). Overall, 26.7% (n = 85) of patients developed in-hospital complications; and mortality occurred in 30% (n = 26) of those patients (i.e., the FTR group). Frail patients had higher rates of FTR (14% vs. 4%, P < 0.001) than nonfrail patients. On regression analysis, after controlling for confounders, frail status was an independent predictor of FTR (OR: 3.4 [2.3-4.6]) in geriatric EGS patients. Conclusions: Our study demonstrates that in geriatric EGS patients, a frail status independently contributes to FTR and increases the odds of FTR threefold compared with nonfrail status. Thus, it should be included in quality metrics for geriatric EGS patients.

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