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Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients.

Publication ,  Journal Article
Arya, S; Long, CA; Brahmbhatt, R; Shafii, S; Brewster, LP; Veeraswamy, R; Johnson, TM; Johanning, JM
Published in: Ann Vasc Surg
August 2016

BACKGROUND: Patient-centered quality outcomes such as disposition after surgery are increasingly being scrutinized. Preoperative factors predictive of nonhome discharge (DC) may identify at-risk patients for targeted interventions. This study examines the association among preoperative risk factors, frailty, and nonhome DC after elective vascular surgery procedures in patients living at home. METHODS: The 2011-2012 National Surgical Quality Improvement Project database was queried to identify all home-dwelling patients who underwent elective vascular procedures (endovascular and open aortic aneurysm repair, suprainguinal and infrainguinal bypasses, peripheral endovascular interventions, carotid endarterectomy, and stent). Preoperative frailty was measured using the modified frailty index (mFI; derived from Canadian Study of Health and Aging). Univariate and multivariate logistic regression analysis was performed to examine the association of frailty and nonhome DC. RESULTS: Of 15,843 home-dwelling patients, 1,177 patients (7.4%) did not return home postoperatively. Frailty (mFI > 0.25) conferred a significantly increased 2-fold risk of nonhome DC disposition for each procedure type. Frailty, female gender, open procedures, increasing age, end-stage renal disease, and occurrence of any postoperative complication were associated with increased risk of nonhome DC. On multivariate logistic regression analysis, frailty increased the odds of nonhome DC by 60% (odds ratio 1.6, 95% confidence interval 1.4-1.8) after adjusting for other covariates. In the presence of complications, the risk of nonhome DC was 27.5% in frail versus 16.5% in nonfrail patients (P < 0.001). In the absence of complications, although absolute risk was lower, frail patients were nearly twice as likely to not return home (frail 5.5% vs. nonfrail 2.75%, P < 0.001). CONCLUSIONS: Frail home-dwelling patients undergoing elective vascular procedures are at high risk of not returning home after surgery. Preoperative frailty assessment appears to hold potential for counseling regarding postsurgery disposition and DC planning.

Duke Scholars

Published In

Ann Vasc Surg

DOI

EISSN

1615-5947

Publication Date

August 2016

Volume

35

Start / End Page

19 / 29

Location

Netherlands

Related Subject Headings

  • Vascular Surgical Procedures
  • Vascular Diseases
  • United States
  • Treatment Outcome
  • Skilled Nursing Facilities
  • Risk Factors
  • Retrospective Studies
  • Rehabilitation Centers
  • Postoperative Complications
  • Patient Transfer
 

Citation

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ICMJE
MLA
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Arya, S., Long, C. A., Brahmbhatt, R., Shafii, S., Brewster, L. P., Veeraswamy, R., … Johanning, J. M. (2016). Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients. Ann Vasc Surg, 35, 19–29. https://doi.org/10.1016/j.avsg.2016.01.052
Arya, Shipra, Chandler A. Long, Reshma Brahmbhatt, Susan Shafii, Luke P. Brewster, Ravi Veeraswamy, Theodore M. Johnson, and Jason M. Johanning. “Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients.Ann Vasc Surg 35 (August 2016): 19–29. https://doi.org/10.1016/j.avsg.2016.01.052.
Arya S, Long CA, Brahmbhatt R, Shafii S, Brewster LP, Veeraswamy R, et al. Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients. Ann Vasc Surg. 2016 Aug;35:19–29.
Arya, Shipra, et al. “Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients.Ann Vasc Surg, vol. 35, Aug. 2016, pp. 19–29. Pubmed, doi:10.1016/j.avsg.2016.01.052.
Arya S, Long CA, Brahmbhatt R, Shafii S, Brewster LP, Veeraswamy R, Johnson TM, Johanning JM. Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients. Ann Vasc Surg. 2016 Aug;35:19–29.
Journal cover image

Published In

Ann Vasc Surg

DOI

EISSN

1615-5947

Publication Date

August 2016

Volume

35

Start / End Page

19 / 29

Location

Netherlands

Related Subject Headings

  • Vascular Surgical Procedures
  • Vascular Diseases
  • United States
  • Treatment Outcome
  • Skilled Nursing Facilities
  • Risk Factors
  • Retrospective Studies
  • Rehabilitation Centers
  • Postoperative Complications
  • Patient Transfer