An age-independent hospital record-based frailty score correlates with adverse outcomes after heart surgery and increased health care costs
Globally, an increasing number of vulnerable or frail patients are undergoing cardiac surgery. However, large-scale frailty data are often limited by the need for time-consuming frailty assessments. This study aimed to (1) create a retrospective registry-based frailty score (FS), (2) determine its e...
Gespeichert in:
| Veröffentlicht in: | JTCVS open 2021-12, Vol.8, p.491-502 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 502 |
|---|---|
| container_issue | |
| container_start_page | 491 |
| container_title | JTCVS open |
| container_volume | 8 |
| creator | Sarkar, Shreya MacLeod, Jeffrey B. Hassan, Ansar Dutton, Daniel J. Brunt, Keith R. Légaré, Jean-François |
| description | Globally, an increasing number of vulnerable or frail patients are undergoing cardiac surgery. However, large-scale frailty data are often limited by the need for time-consuming frailty assessments. This study aimed to (1) create a retrospective registry-based frailty score (FS), (2) determine its effect on outcomes and age, and (3) health care costs.
Retrospective data were obtained from the New Brunswick Heart Centre registry for all cardiac surgery patients between 2012 and 2017. A 20-point FS was created using available binary risk variables. The primary outcomes of interest most relevant to vulnerable patients were prolonged hospitalization, failure to be discharged home, and hospitalization bed cost. Composite outcome of prolonged hospitalization (>8 days) and/or non-home discharge were analyzed using multivariate analysis.
A total of 3463 patients (mean age, 66 ± 10 years) were included in the final analysis. Tercile-based FSs were: low (0-4; n = 856), medium (5-7; n = 1709), high (≥8; n = 898). In unadjusted data, frail patients were older with more comorbidities. High FS patients had greater risks of prolonged hospitalization (median 7 vs 5 days; P |
| doi_str_mv | 10.1016/j.xjon.2021.10.018 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9390592</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S2666273621003727</els_id><sourcerecordid>2706719267</sourcerecordid><originalsourceid>FETCH-LOGICAL-c432t-7793f8c30133cf9386959d05fc4407e99477b7aedd2fbfbec35947cf82f22aee3</originalsourceid><addsrcrecordid>eNp9kc1uEzEUhS0EolXpC7Dyks0E_8zYYwkhVRUFpEpsYG157OvE0cQOtieQZ-hL4zQVKhs219a593xX9kHoLSUrSqh4v1393qa4YoTRJqwIHV-gSyaE6Jjk4uWz-wW6LmVLCGED5cMwvkYXXBDSk1FcooebiM0auhAd7KGVWPEmlX2oZsYZbMqum0wBh302Ya5HXJoGuJUMs6lQ8K9QN9i4A-QCOC3Vpl1Tja-Q8QZMrrgseQ35iE10OESb4RHYenNzWvOIK7W8Qa-8mQtcP51X6Mfdp--3X7r7b5-_3t7cd7bnrHZSKu5Hywnl3HrFR6EG5cjgbd8TCUr1Uk7SgHPMT34Cy4cmWT8yz5gB4Ffo45m7X6YdONvenM2s9znsTD7qZIL-txPDRq_TQSuuyKBYA7x7AuT0c4FS9S4UC_NsIqSlaCaJkFQxIdsoO4_anErJ4P-uoUSfgtRbfQpSn4I8aS3IZvpwNkH7hUOArIsNEC240CKp2qXwP_sfFrmqGw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2706719267</pqid></control><display><type>article</type><title>An age-independent hospital record-based frailty score correlates with adverse outcomes after heart surgery and increased health care costs</title><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Sarkar, Shreya ; MacLeod, Jeffrey B. ; Hassan, Ansar ; Dutton, Daniel J. ; Brunt, Keith R. ; Légaré, Jean-François</creator><creatorcontrib>Sarkar, Shreya ; MacLeod, Jeffrey B. ; Hassan, Ansar ; Dutton, Daniel J. ; Brunt, Keith R. ; Légaré, Jean-François</creatorcontrib><description>Globally, an increasing number of vulnerable or frail patients are undergoing cardiac surgery. However, large-scale frailty data are often limited by the need for time-consuming frailty assessments. This study aimed to (1) create a retrospective registry-based frailty score (FS), (2) determine its effect on outcomes and age, and (3) health care costs.
Retrospective data were obtained from the New Brunswick Heart Centre registry for all cardiac surgery patients between 2012 and 2017. A 20-point FS was created using available binary risk variables. The primary outcomes of interest most relevant to vulnerable patients were prolonged hospitalization, failure to be discharged home, and hospitalization bed cost. Composite outcome of prolonged hospitalization (>8 days) and/or non-home discharge were analyzed using multivariate analysis.
A total of 3463 patients (mean age, 66 ± 10 years) were included in the final analysis. Tercile-based FSs were: low (0-4; n = 856), medium (5-7; n = 1709), high (≥8; n = 898). In unadjusted data, frail patients were older with more comorbidities. High FS patients had greater risks of prolonged hospitalization (median 7 vs 5 days; P < .001), lower home-discharge rates (51% vs 83%; P < .001), higher 30-day readmission rates (18% vs 10%; P < .001), and increased 30-day mortality rates (≤0.7% [low], >0.7% to ≤1.2% [medium], and >1.2% to 4.8% [high]; P < .001). After statistical adjustment, the FS was an independent predictor of composite outcome (odds ratio, 1.3: 95% CI, 1.26-1.35), and increased hospital bed costs.
A registry-based FS can be used to identify vulnerable or frail patients undergoing cardiac surgery and was associated with poor outcomes independent of age. This highlights that although frailty defined by increased vulnerability is often associated with older age, it is not a surrogate for aging, thereby having important implications in reducing health system costs and efforts to provide streamlined care to the most vulnerable.
[Display omitted]</description><identifier>ISSN: 2666-2736</identifier><identifier>EISSN: 2666-2736</identifier><identifier>DOI: 10.1016/j.xjon.2021.10.018</identifier><identifier>PMID: 36004086</identifier><language>eng</language><publisher>Elsevier Inc</publisher><subject>Adult: Perioperative Management ; deficits ; prolonged stay ; readmission ; retrospective ; risks</subject><ispartof>JTCVS open, 2021-12, Vol.8, p.491-502</ispartof><rights>2021 The Author(s)</rights><rights>2021 The Author(s) 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c432t-7793f8c30133cf9386959d05fc4407e99477b7aedd2fbfbec35947cf82f22aee3</citedby><cites>FETCH-LOGICAL-c432t-7793f8c30133cf9386959d05fc4407e99477b7aedd2fbfbec35947cf82f22aee3</cites><orcidid>0000-0002-6397-1969</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390592/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390592/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids></links><search><creatorcontrib>Sarkar, Shreya</creatorcontrib><creatorcontrib>MacLeod, Jeffrey B.</creatorcontrib><creatorcontrib>Hassan, Ansar</creatorcontrib><creatorcontrib>Dutton, Daniel J.</creatorcontrib><creatorcontrib>Brunt, Keith R.</creatorcontrib><creatorcontrib>Légaré, Jean-François</creatorcontrib><title>An age-independent hospital record-based frailty score correlates with adverse outcomes after heart surgery and increased health care costs</title><title>JTCVS open</title><description>Globally, an increasing number of vulnerable or frail patients are undergoing cardiac surgery. However, large-scale frailty data are often limited by the need for time-consuming frailty assessments. This study aimed to (1) create a retrospective registry-based frailty score (FS), (2) determine its effect on outcomes and age, and (3) health care costs.
Retrospective data were obtained from the New Brunswick Heart Centre registry for all cardiac surgery patients between 2012 and 2017. A 20-point FS was created using available binary risk variables. The primary outcomes of interest most relevant to vulnerable patients were prolonged hospitalization, failure to be discharged home, and hospitalization bed cost. Composite outcome of prolonged hospitalization (>8 days) and/or non-home discharge were analyzed using multivariate analysis.
A total of 3463 patients (mean age, 66 ± 10 years) were included in the final analysis. Tercile-based FSs were: low (0-4; n = 856), medium (5-7; n = 1709), high (≥8; n = 898). In unadjusted data, frail patients were older with more comorbidities. High FS patients had greater risks of prolonged hospitalization (median 7 vs 5 days; P < .001), lower home-discharge rates (51% vs 83%; P < .001), higher 30-day readmission rates (18% vs 10%; P < .001), and increased 30-day mortality rates (≤0.7% [low], >0.7% to ≤1.2% [medium], and >1.2% to 4.8% [high]; P < .001). After statistical adjustment, the FS was an independent predictor of composite outcome (odds ratio, 1.3: 95% CI, 1.26-1.35), and increased hospital bed costs.
A registry-based FS can be used to identify vulnerable or frail patients undergoing cardiac surgery and was associated with poor outcomes independent of age. This highlights that although frailty defined by increased vulnerability is often associated with older age, it is not a surrogate for aging, thereby having important implications in reducing health system costs and efforts to provide streamlined care to the most vulnerable.
[Display omitted]</description><subject>Adult: Perioperative Management</subject><subject>deficits</subject><subject>prolonged stay</subject><subject>readmission</subject><subject>retrospective</subject><subject>risks</subject><issn>2666-2736</issn><issn>2666-2736</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc1uEzEUhS0EolXpC7Dyks0E_8zYYwkhVRUFpEpsYG157OvE0cQOtieQZ-hL4zQVKhs219a593xX9kHoLSUrSqh4v1393qa4YoTRJqwIHV-gSyaE6Jjk4uWz-wW6LmVLCGED5cMwvkYXXBDSk1FcooebiM0auhAd7KGVWPEmlX2oZsYZbMqum0wBh302Ya5HXJoGuJUMs6lQ8K9QN9i4A-QCOC3Vpl1Tja-Q8QZMrrgseQ35iE10OESb4RHYenNzWvOIK7W8Qa-8mQtcP51X6Mfdp--3X7r7b5-_3t7cd7bnrHZSKu5Hywnl3HrFR6EG5cjgbd8TCUr1Uk7SgHPMT34Cy4cmWT8yz5gB4Ffo45m7X6YdONvenM2s9znsTD7qZIL-txPDRq_TQSuuyKBYA7x7AuT0c4FS9S4UC_NsIqSlaCaJkFQxIdsoO4_anErJ4P-uoUSfgtRbfQpSn4I8aS3IZvpwNkH7hUOArIsNEC240CKp2qXwP_sfFrmqGw</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Sarkar, Shreya</creator><creator>MacLeod, Jeffrey B.</creator><creator>Hassan, Ansar</creator><creator>Dutton, Daniel J.</creator><creator>Brunt, Keith R.</creator><creator>Légaré, Jean-François</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6397-1969</orcidid></search><sort><creationdate>20211201</creationdate><title>An age-independent hospital record-based frailty score correlates with adverse outcomes after heart surgery and increased health care costs</title><author>Sarkar, Shreya ; MacLeod, Jeffrey B. ; Hassan, Ansar ; Dutton, Daniel J. ; Brunt, Keith R. ; Légaré, Jean-François</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c432t-7793f8c30133cf9386959d05fc4407e99477b7aedd2fbfbec35947cf82f22aee3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult: Perioperative Management</topic><topic>deficits</topic><topic>prolonged stay</topic><topic>readmission</topic><topic>retrospective</topic><topic>risks</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sarkar, Shreya</creatorcontrib><creatorcontrib>MacLeod, Jeffrey B.</creatorcontrib><creatorcontrib>Hassan, Ansar</creatorcontrib><creatorcontrib>Dutton, Daniel J.</creatorcontrib><creatorcontrib>Brunt, Keith R.</creatorcontrib><creatorcontrib>Légaré, Jean-François</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JTCVS open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sarkar, Shreya</au><au>MacLeod, Jeffrey B.</au><au>Hassan, Ansar</au><au>Dutton, Daniel J.</au><au>Brunt, Keith R.</au><au>Légaré, Jean-François</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An age-independent hospital record-based frailty score correlates with adverse outcomes after heart surgery and increased health care costs</atitle><jtitle>JTCVS open</jtitle><date>2021-12-01</date><risdate>2021</risdate><volume>8</volume><spage>491</spage><epage>502</epage><pages>491-502</pages><issn>2666-2736</issn><eissn>2666-2736</eissn><abstract>Globally, an increasing number of vulnerable or frail patients are undergoing cardiac surgery. However, large-scale frailty data are often limited by the need for time-consuming frailty assessments. This study aimed to (1) create a retrospective registry-based frailty score (FS), (2) determine its effect on outcomes and age, and (3) health care costs.
Retrospective data were obtained from the New Brunswick Heart Centre registry for all cardiac surgery patients between 2012 and 2017. A 20-point FS was created using available binary risk variables. The primary outcomes of interest most relevant to vulnerable patients were prolonged hospitalization, failure to be discharged home, and hospitalization bed cost. Composite outcome of prolonged hospitalization (>8 days) and/or non-home discharge were analyzed using multivariate analysis.
A total of 3463 patients (mean age, 66 ± 10 years) were included in the final analysis. Tercile-based FSs were: low (0-4; n = 856), medium (5-7; n = 1709), high (≥8; n = 898). In unadjusted data, frail patients were older with more comorbidities. High FS patients had greater risks of prolonged hospitalization (median 7 vs 5 days; P < .001), lower home-discharge rates (51% vs 83%; P < .001), higher 30-day readmission rates (18% vs 10%; P < .001), and increased 30-day mortality rates (≤0.7% [low], >0.7% to ≤1.2% [medium], and >1.2% to 4.8% [high]; P < .001). After statistical adjustment, the FS was an independent predictor of composite outcome (odds ratio, 1.3: 95% CI, 1.26-1.35), and increased hospital bed costs.
A registry-based FS can be used to identify vulnerable or frail patients undergoing cardiac surgery and was associated with poor outcomes independent of age. This highlights that although frailty defined by increased vulnerability is often associated with older age, it is not a surrogate for aging, thereby having important implications in reducing health system costs and efforts to provide streamlined care to the most vulnerable.
[Display omitted]</abstract><pub>Elsevier Inc</pub><pmid>36004086</pmid><doi>10.1016/j.xjon.2021.10.018</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-6397-1969</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2666-2736 |
| ispartof | JTCVS open, 2021-12, Vol.8, p.491-502 |
| issn | 2666-2736 2666-2736 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9390592 |
| source | DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Adult: Perioperative Management deficits prolonged stay readmission retrospective risks |
| title | An age-independent hospital record-based frailty score correlates with adverse outcomes after heart surgery and increased health care costs |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T07%3A23%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=An%20age-independent%20hospital%20record-based%20frailty%20score%20correlates%20with%20adverse%20outcomes%20after%20heart%20surgery%20and%20increased%20health%20care%20costs&rft.jtitle=JTCVS%20open&rft.au=Sarkar,%20Shreya&rft.date=2021-12-01&rft.volume=8&rft.spage=491&rft.epage=502&rft.pages=491-502&rft.issn=2666-2736&rft.eissn=2666-2736&rft_id=info:doi/10.1016/j.xjon.2021.10.018&rft_dat=%3Cproquest_pubme%3E2706719267%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2706719267&rft_id=info:pmid/36004086&rft_els_id=S2666273621003727&rfr_iscdi=true |