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Association Between Patient-Reported Frailty and Non-Home Discharge Among Older Adults Undergoing Surgery.

Claire M Sokas1, Jane Cowan2, Michael K Dalton1

  • 1Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.

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Preoperative frailty screening using the FRAIL tool can identify surgical patients at higher risk for non-home discharge (NHD). This practical screening helps anticipate discharge needs and improve care planning for older adults.

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Area of Science:

  • Geriatric Medicine
  • Surgical Patient Outcomes
  • Healthcare Management

Background:

  • Identifying patients at risk for non-home discharge (NHD) is crucial for optimizing hospital stays and postoperative care.
  • Preoperative frailty screening can potentially improve discharge planning and patient satisfaction.

Purpose of the Study:

  • To investigate the association between positive responses on a preoperative patient-reported frailty screen and non-home discharge (NHD).
  • To evaluate the utility of the FRAIL (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) screen in predicting discharge destination for surgical patients.

Main Methods:

  • A prospective cohort study was conducted with patients aged 60 and older undergoing major elective surgery.
  • A modified FRAIL screen assessed fatigue, activity against resistance, ambulation, and weight loss.
  • Multivariable logistic regression analyzed the association between frailty screen responses and NHD, adjusting for age and sex.

Main Results:

  • Of 230 patients, 10.4% had an NHD.
  • Patients with NHD were more likely to report preoperative fatigue, weight loss, and difficulty with activity against resistance.
  • A positive FRAIL screen (≥2 items) significantly predicted NHD (OR=4.5), as did any positive response (OR=2.5).
  • Difficulty with activity against resistance (OR=7.6) and weight loss (OR=7.9) showed high odds of NHD.

Conclusions:

  • Patient-reported frailty, assessed via the FRAIL screen, effectively identifies individuals at high risk for non-home discharge.
  • The FRAIL screening tool is practical for preoperative use to anticipate complex discharge planning needs.
  • Implementing this screening can enhance preoperative counseling and resource allocation for at-risk surgical patients.