Association of a Frailty Screening Initiative With Postoperative Survival at 30, 180, and 365 Days

Area of Science:

• Geriatric Medicine
• Surgical Outcomes
• Quality Improvement

Background:

• The aging US population necessitates better strategies for managing surgical risks in elderly patients.
• Frailty is a stronger predictor of postoperative mortality and morbidity than chronological age alone.
• Identifying and managing frail surgical patients presents an opportunity to improve outcomes.

Purpose of the Study:

• To evaluate the impact of the Frailty Screening Initiative (FSI) on postoperative mortality and complications.
• To compare surgical outcomes in patients treated before and after the FSI implementation.
• To assess the feasibility and efficacy of a facility-wide frailty screening program.

Main Methods:

• A prospective, facility-wide cohort study of 9153 major elective noncardiac surgery patients.
• Implementation of the Risk Analysis Index (RAI) for preoperative frailty assessment starting July 2011.
• Administrative review of frail patients (RAI score ≥21) with multidisciplinary team input for perioperative plan modification.

Main Results:

• Overall 30-day mortality decreased from 1.6% to 0.7% post-FSI implementation (P < .001).
• Mortality reduction was most pronounced in frail patients (12.2% to 3.8%, P < .001) and also observed in robust patients.
• Improved survival at 180 and 365 days was noted, with adjusted odds ratio for 180-day survival of 2.87 (95% CI, 1.98-4.16).

Conclusions:

• The FSI was associated with a significant reduction in postoperative mortality.
• Widespread preoperative screening for frailty is feasible and effective in improving surgical outcomes.
• System-level initiatives targeting frailty can enhance patient safety in surgical settings.