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Frailty as an independent risk factor for prolonged postoperative length of stay: A retrospective analysis of 2015-2019 ACS NSQIP data.

Authors :
Xu JY
Madden HE
Martínez-Camblor P
Deiner SG
Source :
Journal of clinical anesthesia [J Clin Anesth] 2025 Feb; Vol. 101, pp. 111730. Date of Electronic Publication: 2024 Dec 20.
Publication Year :
2025

Abstract

Background: Frailty, a syndrome of decreased resilience to physiologic stress, has been associated with increased postoperative length of stay (LOS) for specific procedures. Yet, the literature lacks large-scale analyses examining the relationship between frailty and LOS across surgical procedure.<br />Study Design: We conducted a retrospective cohort study of patients aged 65+ undergoing inpatient surgery including emergency procedures between 2015 and 2019 using American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) data. Frailty, measured by the modified 5-item frailty index (mFI-5), was categorized as non-frail (mFI-5 < 2) or frail (mFI-5 ≥ 2). We modeled LOS, adjusting for demographic variables, comorbidities, and surgical factors, and conducted a subgroup analysis based on emergency surgery status and surgical procedure type.<br />Main Results: Among 1,254,809 patients, 29.0 % were frail. A higher proportion of frail patients were Black (10 % vs. 5.5 %), Hispanic (6.1 % vs. 3.8 %), of ASA class IV/V (23.3 % vs. 9.1 %), malnourished (2.7 % vs. 1.9 %), and underwent vascular surgery (16.5 % vs. 8.3 %). They experienced longer median LOS across all surgical procedures, except bariatric surgery. Unadjusted analysis revealed that mFI-5 scores of 4 and 5 were associated with increased median LOS by 3.5 days (95 % CI 3.36-3.64) and 4.64 days (95 % CI 3.96-5.32), respectively, compared to mFI-5 scores of 0. In adjusted analysis, frailty remained a significant risk factor for increased median LOS, with an mFI-5 score of 5 associated with a 3-day longer increase (95 % CI 2.79-3.22) compared to an mFI-5 score of 0. Subgroup analysis showed that each one-point increase in mFI-5 score had the strongest association with increased median LOS in emergency surgery (0.5 days, 95 % CI 0.48-0.52) and lower extremity bypass surgery (0.53 days, 95 % CI 0.47-0.59).<br />Conclusions: Frailty is an independent risk factor for prolonged postoperative LOS among older surgical patients, even after adjustment for patient and procedure covariates. Other independent risk factors for increased LOS include emergent surgery, malnutrition, and higher ASA class.<br />Competing Interests: Declaration of competing interest Stacie G. Deiner reports financial support was provided by the LeRoy Garth Endowment from the Geisel School of Medicine and the Dartmouth Hitchcock Medical Center Department of Anesthesiology. Stacie G. Deiner reports a relationship with The American Board of Anesthesiology that includes: board membership, any views expressed in this manuscript are her own and not necessarily those of the American Board of Anesthesiology. Co-author has served as an expert witness - S.G.D. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.<br /> (Copyright © 2024. Published by Elsevier Inc.)

Details

Language :
English
ISSN :
1873-4529
Volume :
101
Database :
MEDLINE
Journal :
Journal of clinical anesthesia
Publication Type :
Academic Journal
Accession number :
39708560
Full Text :
https://doi.org/10.1016/j.jclinane.2024.111730