Can Routine Preoperative Data Predict Adverse Outcomes in the Elderly? Development and Validation of a Simple Risk Model Incorporating a Chart-Derived Frailty Score - 19/09/14
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Abstract |
Background |
Frailty has emerged as an important predictor of operative risk among elderly surgical patients. However, the complexity of prospective frailty scores has limited their widespread use. Our goal was to develop two frailty-based surgical risk models using only routine preoperative data. Our hypothesis was that these models could easily integrate into an electronic medical record to predict 30-day morbidity and mortality.
Study Design |
American College of Surgeons NSQIP Participant Use Data Files from 2005 to 2010 were reviewed, and patients 65 years and older who underwent elective lower gastrointestinal surgery were identified. Two multivariate logistic regression models were constructed and internally cross-validated. The first included simple functional data, a comorbidity index based on the Charlson Comorbidity Index, demographics, BMI, and laboratory data (ie, albumin <3.4 g/dL, hematocrit <35%, and creatinine >2 mg/dL). The second model contained only parameters that can directly autopopulate from an electronic medical record (ie, demographics, laboratory data, BMI, and American Society of Anesthesiologists score). To assess diagnostic accuracy, receiver operating characteristic curves were constructed.
Results |
There were 76,106 patients who met criteria for inclusion. Thirty-day mortality was seen in 2,853 patients or 3.7% of the study population and 18,436 patients (24.2%) experienced a major complication. The c-statistic of the first expanded model was 0.813 for mortality and 0.629 for morbidity. The second simplified model had a c-statistic of 0.795 for mortality and 0.621 for morbidity. Both models were well calibrated per the Hosmer-Lemeshow test.
Conclusions |
Our work demonstrates that routine preoperative data can approximate frailty and predict geriatric-specific surgical risk. The models' predicative powers were comparable with that of established prospective frailty scores. Our calculator could be used as a low-cost simple screen for high-risk individuals who might require additional evaluation or specialized services.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : ACS, ASA PS, EMR, mFI, SSI
Plan
Disclosure Information: Nothing to disclose. |
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Disclosures outside the scope of this work: Dr Deiner has received pay as an expert witness and received pay for meeting expenses unrelated to the content of this article. |
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This research is supported by NIH GEMSSTAR1 R03 AG040624-01, NIH R01 AG029656-01A1, NIA K08AG043548-01, the American Geriatrics Society Jahnigan Scholar Program, and the Foundation for Anesthesia Education and Research (FAER). |
Vol 219 - N° 4
P. 684-694 - octobre 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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