Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients

Muhammad Khan, Asad Azim, Terence S Okeeffe, Faisal Jehan, Narong Kulvatunyou, Chelsey Santino, Andrew - Tang, Gary - Vercruysse, Lynn Gries, Bellal A Joseph

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. Methods: 3-year(2013-15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor. Geriatric-Rescue-After-Surgery(GRAS)-score calculated for each-patient. AUROC used to assess model discrimination. Results: 725 EGS-patients analyzed. 44.6%(n = 324) had major-complications. The FTR-rate was 11.5%. Overall-mortality rate was 15.3%. On regression, significant-factors with their estimated-weights were:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2). AUROC of score was 0.787. Conclusion: GRAS-score is first score based on preoperative assessment that can reliably predict FTR in EGS-GP. Preoperative identification of patients at increased-risk of FTR can help in risk-stratification and timely-mobilization of resources for successful rescue of these patients.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateAccepted/In press - 2017

Fingerprint

Geriatrics
Emergencies
Weights and Measures
Chronic Obstructive Pulmonary Disease
Statistical Factor Analysis
Chronic Kidney Failure
Heart Failure
Odds Ratio
Regression Analysis
Mortality

Keywords

  • Emergency general surgery
  • Failure to rescue
  • Geriatric surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients. / Khan, Muhammad; Azim, Asad; Okeeffe, Terence S; Jehan, Faisal; Kulvatunyou, Narong; Santino, Chelsey; Tang, Andrew -; Vercruysse, Gary -; Gries, Lynn; Joseph, Bellal A.

In: American Journal of Surgery, 2017.

Research output: Contribution to journalArticle

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title = "Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients",
abstract = "Background: Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. Methods: 3-year(2013-15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor. Geriatric-Rescue-After-Surgery(GRAS)-score calculated for each-patient. AUROC used to assess model discrimination. Results: 725 EGS-patients analyzed. 44.6{\%}(n = 324) had major-complications. The FTR-rate was 11.5{\%}. Overall-mortality rate was 15.3{\%}. On regression, significant-factors with their estimated-weights were:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2). AUROC of score was 0.787. Conclusion: GRAS-score is first score based on preoperative assessment that can reliably predict FTR in EGS-GP. Preoperative identification of patients at increased-risk of FTR can help in risk-stratification and timely-mobilization of resources for successful rescue of these patients.",
keywords = "Emergency general surgery, Failure to rescue, Geriatric surgery",
author = "Muhammad Khan and Asad Azim and Okeeffe, {Terence S} and Faisal Jehan and Narong Kulvatunyou and Chelsey Santino and Tang, {Andrew -} and Vercruysse, {Gary -} and Lynn Gries and Joseph, {Bellal A}",
year = "2017",
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AU - Khan, Muhammad

AU - Azim, Asad

AU - Okeeffe, Terence S

AU - Jehan, Faisal

AU - Kulvatunyou, Narong

AU - Santino, Chelsey

AU - Tang, Andrew -

AU - Vercruysse, Gary -

AU - Gries, Lynn

AU - Joseph, Bellal A

PY - 2017

Y1 - 2017

N2 - Background: Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. Methods: 3-year(2013-15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor. Geriatric-Rescue-After-Surgery(GRAS)-score calculated for each-patient. AUROC used to assess model discrimination. Results: 725 EGS-patients analyzed. 44.6%(n = 324) had major-complications. The FTR-rate was 11.5%. Overall-mortality rate was 15.3%. On regression, significant-factors with their estimated-weights were:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2). AUROC of score was 0.787. Conclusion: GRAS-score is first score based on preoperative assessment that can reliably predict FTR in EGS-GP. Preoperative identification of patients at increased-risk of FTR can help in risk-stratification and timely-mobilization of resources for successful rescue of these patients.

AB - Background: Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. Methods: 3-year(2013-15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor. Geriatric-Rescue-After-Surgery(GRAS)-score calculated for each-patient. AUROC used to assess model discrimination. Results: 725 EGS-patients analyzed. 44.6%(n = 324) had major-complications. The FTR-rate was 11.5%. Overall-mortality rate was 15.3%. On regression, significant-factors with their estimated-weights were:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2). AUROC of score was 0.787. Conclusion: GRAS-score is first score based on preoperative assessment that can reliably predict FTR in EGS-GP. Preoperative identification of patients at increased-risk of FTR can help in risk-stratification and timely-mobilization of resources for successful rescue of these patients.

KW - Emergency general surgery

KW - Failure to rescue

KW - Geriatric surgery

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