Highlights
- •A validated risk score for frailty is associated with an increased risk for the composite of in-hospital mortality, acute myocardial infarction, or cardiac arrest after non-cardiac surgery.
- •The association between high frailty and surgical outcomes were observed across age groups, with greater odds of cardiac events observed in younger individuals.
- •High frailty scores are associated with an increased likelihood of non-home discharge after non-cardiac surgery.
ABSTRACT
Objective
Frailty is an emerging risk factor for adverse outcomes. However, perioperative frailty
assessments derived from electronic health records (EHR) have not been studied on
a large scale. We aim to estimate the prevalence of frailty and the associated incidence
of major adverse cardiovascular events (MACE) among adults hospitalized for non-cardiac
surgery.
Methods
Adults aged ≥45 years hospitalized for non-cardiac surgery between 2004-2014 were
identified from the National Inpatient Sample. The validated Hospital Frailty Risk
Score (HFRS) derived from International Classification of Diseases codes was used
to classify patients as low (HFRS <5), medium (5-10), or high (>10) frailty risk.
The primary outcome was MACE, defined as myocardial infarction, cardiac arrest, and
in-hospital mortality. Multivariable logistic regression was used to estimate the
adjusted odds of MACE stratified by age and HFRS.
Results
A total of 55,349,978 hospitalizations were identified, of which 81.0%, 14.4%, and
4.6% had low, medium, and high HFRS, respectively. Patients with higher HFRS had more
cardiovascular risk factors and comorbidities. MACE occurred during 2.5% of surgical
hospitalizations and was common among patients with high frailty scores (high HFRS:
9.1%, medium: 6.9%, low: 1.3%, p<0.001). Medium (adjusted odds ratio [aOR] 2.05, 95%
CI 2.02 to 2.08) and high (aOR 2.75, 95% CI 2.70 to 2.79) HFRS were associated with
greater odds of MACE versus low HFRS, with the greatest odds of MACE observed in younger
individuals 45-64 years (interaction p-value <0.001).
Conclusions
The HFRS may identify frail surgical inpatients at risk for adverse perioperative
cardiovascular outcomes.
Keywords
Abbreviations:
EHR (electronic health record), MACE (major adverse cardiovascular events), AHRQ (Agency for Healthcare Research and Quality), NIS (National Inpatient Sample), ICD (International Classification of Disease), HFRS (hospital frailty risk score)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
December 18,
2022
Received:
July 6,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Declaration of Interest: Dr. Smilowitz is supported, in part, by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K23HL150315
Authorship Contributions: All authors have reviewed the manuscript and are in agreement of the submission for publication.
Funding: None
Identification
Copyright
© 2023 Published by Elsevier Inc.
