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Association of the Modified Frailty Index With 30-Day Surgical Readmission
Tyler S Wahl1,2, Laura A Graham1,2, Mary T Hawn3,4
1Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.
Importance:
Frail patients are known to have poor perioperative outcomes. There is a paucity of literature investigating how the Modified Frailty Index (mFI), a validated measure of frailty, is associated with unplanned readmission among military veterans following surgery.
Objective:
To understand the association between frailty and 30-day postoperative unplanned readmission.
Design, Setting, And Participants:
A retrospective cohort study was conducted among adult patients who underwent surgery and were discharged alive from Veterans Affairs hospitals for orthopedic, general, and vascular conditions between October 1, 2007, and September 30, 2014, with a postoperative length of stay between 2 and 30 days.
Exposure:
Frailty, as calculated by the 11 variables on the mFI.
Main Outcomes And Measures:
The primary outcome of interest is 30-day unplanned readmission. Secondary outcomes included any 30-day predischarge or postdischarge complication, 30-day postdischarge mortality, and 30-day emergency department visit.
Results:
The study sample included 236 957 surgical procedures (among 223 877 men and 13 080 women; mean [SD] age, 64.0 [11.3] years) from high-volume surgical specialties: 101 348 procedures (42.8%) in orthopedic surgery, 92 808 procedures (39.2%) in general surgery, and 42 801 procedures (18.1%) in vascular surgery. The mFI was associated with readmission (odds ratio [OR], 1.11; 95% CI, 1.10-1.12; R2 = 10.3%; C statistic, 0.71). Unadjusted rates of overall 30-day readmission (26 262 [11.1%]), postdischarge emergency department visit (34 204 [14.4%]), any predischarge (13 855 [5.9%]) or postdischarge (14 836 [6.3%]) complication, and postdischarge mortality (1985 [0.8%]) varied by frailty in a dose-dependent fashion. In analysis by individual mFI components using Harrell ranking, impaired functional status, identified as nonindependent functional status (OR, 1.16; 95% CI, 1.11-1.21; P < .01) or having a residual deficit from a prior cerebrovascular accident (OR, 1.17; 95% CI, 1.11-1.22; P < .01), contributed most to the ability of the mFI to anticipate readmission compared with the other components. Acutely impaired sensorium (OR, 1.12; 95% CI, 0.99-1.27; P = .08) and history of a myocardial infarction within 6 months (OR, 0.93; 95% CI, 0.81-1.06; P = .28) were not significantly associated with readmission.
Conclusions And Relevance:
The mFI is associated with poor surgical outcomes, including readmission, primarily due to impaired functional status. Targeting potentially modifiable aspects of frailty preoperatively, such as improving functional status, may improve perioperative outcomes and decrease readmissions.
Insights
The Modified Frailty Index (mFI) predicts unplanned surgical readmissions in veterans, with functional status being a key factor. Interventions to improve functional status may reduce readmissions.
Area of Science:
- Geriatric Surgery
- Health Services Research
- Patient Outcomes
Background:
- Frail patients experience worse surgical outcomes.
- The Modified Frailty Index (mFI) is a validated measure of frailty.
- Limited research exists on mFI and unplanned readmissions in veterans.
Purpose of the Study:
- To examine the association between frailty and 30-day unplanned readmissions after surgery in veterans.
- To identify specific frailty components contributing to readmission risk.
Main Methods:
- Retrospective cohort study of over 236,000 veteran surgeries (orthopedic, general, vascular) from 2007-2014.
- Frailty assessed using the 11-variable Modified Frailty Index (mFI).
- Primary outcome: 30-day unplanned readmission; secondary outcomes included complications, mortality, and ED visits.
Main Results:
- The mFI was significantly associated with 30-day readmission (OR 1.11).
- Higher mFI scores correlated with increased rates of readmission, complications, and mortality in a dose-dependent manner.
- Impaired functional status (nonindependent status or post-stroke deficit) was the strongest predictor of readmission within the mFI components.
Conclusions:
- The Modified Frailty Index is a strong predictor of adverse surgical outcomes, particularly unplanned readmissions in veterans.
- Impaired functional status is a primary driver of readmission risk associated with frailty.
- Preoperative interventions targeting functional status may mitigate frailty-related readmissions and improve surgical outcomes.
