Accumulated Frailty Characteristics Predict Postoperative Discharge Institutionalization in the Geriatric Patient - 10/08/11

Doi : 10.1016/j.jamcollsurg.2011.01.056

Thomas N. Robinson, MD. FACS ^a,^c,^⁎ , Jeffrey I. Wallace, MD ^b, Daniel S. Wu, MD ^a,^c, Arek Wiktor, MD ^a,^c, Lauren F. Pointer, MS ^d, Shirley M. Pfister, RN, MS, NP ^e, Terra J. Sharp, NP-C ^e, Mary J. Buckley, NP ^e, Marc Moss, MD ^b
^a Department of Surgery, University of Colorado at Denver School of Medicine, Aurora, CO
^b Department of Medicine, University of Colorado at Denver School of Medicine, Aurora, CO
^c Department of Surgery, Denver Veteran's Affairs Medical Center, Denver, CO
^d Department of Biostatistics, Denver Veteran's Affairs Medical Center, Denver, CO
^e Department of Anesthesia, Denver Veteran's Affairs Medical Center, Denver, CO

Correspondence address: Thomas Robinson, MD, FACS, 12631 East 17th Ave., MS C313, Aurora, CO 80045

Résumé

Background

Frailty is a state of increased vulnerability to health-related stressors and can be measured by summing the number of frailty characteristics present in an individual. Discharge institutionalization (rather than discharge to home) represents disease burden and functional dependence after hospitalization. Our aim was to determine the relationship between frailty and need for postoperative discharge institutionalization.

Study Design

Subjects ≥65 years undergoing major elective operations requiring postoperative ICU admission were enrolled. Discharge institutionalization was defined as need for institutionalized care at hospital discharge. Fourteen preoperative frailty characteristics were measured in 6 domains: comorbidity burden, function, nutrition, cognition, geriatric syndromes, and extrinsic frailty.

Results

A total of 223 subjects (mean age 73 ± 6 years) were studied. Discharge institutionalization occurred in 30% (n = 66). Frailty characteristics related to need for postoperative discharge institutionalization included: older age, Charlson index ≥3, hematocrit <35%, any functional dependence, up-and-go ≥15 seconds, albumin <3.4 mg/dL, Mini-Cog score ≤3, and having fallen within 6 months (p < 0.0001 for all comparisons). Multivariate logistic regression retained prolonged timed up-and-go (p < 0.0001) and any functional dependence (p < 0.0001) as the variables most closely related to need for discharge institutionalization. An increased number of frailty characteristics present in any one subject resulted in increased rate of discharge institutionalization.

Conclusions

Nearly 1 in 3 geriatric patients required discharge to an institutional care facility after major surgery. The frailty characteristics of prolonged up-and-go and any functional dependence were most closely related to the need for discharge institutionalization. Accumulation of a higher number of frailty characteristics in any one geriatric patient increased their risk of discharge institutionalization.

Le texte complet de cet article est disponible en PDF.

Plan

	Disclosure Information: Nothing to disclose.
	Supported by the Paul B Beeson Award, NIA K23AG034632 (Robinson), Dennis W Jahnigen Award, American Geriatrics Society (Robinson), and National Institutes of Health grant K24-HL-089223 (Moss).