The Effect of Frailty on Independent Living After Surgery: A Population-Based Retrospective Cohort Study

Background Most people value quality of life over mere duration. At least 50% of people are extremely averse to ever living in a nursing home (NH). Objectives Assess whether pre-operative frailty is associated with new, post-operative NH placement. Design, Setting Retrospective, population-based cohort study in the Canadian province of Manitoba, 2000–2017. Participants 7408 persons ≥65 years undergoing any of 16 specific, elective, noncardiac surgeries of varying Operative Surgical Stress (OSS). Measurements The primary outcome was new admission to a NH, or being placed on a waiting list for a NH, within 180 days of index hospital admission, among index hospital survivors. Frailty was assessed from administrative data by the Preoperative Frailty Index (pFI), which ranges 0–1. Other outcomes were 30-day and 90–180 day mortality, and post-hospital medical resource use to 180 days. Analyses used multivariable regression models, adjusted for age, sex, OSS, year of surgery, anesthetic technique, and socioeconomic status. P-values were adjusted for the six outcomes. Results Subjects had mean age (±SD) of 74±7 yrs; 61% were male. pFI ranged 0–0.68, with a mean±SD of 0.21±0.09. All six outcomes were significantly associated with greater frailty. Each additional 0.1 unit increase in pFI was associated with a hazard ratio for new NH admission or wait-listing of 3.01 (p