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Automated Frailty Screening At-Scale for Pre-Operative Risk Stratification Using the Electronic Frailty Index.

Kathryn E Callahan1,2, Clancy J Clark2,3, Angela F Edwards4

  • 1Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Journal of the American Geriatrics Society
|January 20, 2021
PubMed
Summary
This summary is machine-generated.

An electronic frailty index (eFI) integrated into EHRs can identify frail older adults undergoing surgery. This automated tool predicts increased post-acute care needs, readmissions, and mortality, enabling scalable pre-operative screening.

Keywords:
frailtyhealthcare utilizationpreoperative assessment

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Area of Science:

  • Geriatric Medicine
  • Surgical Outcomes Research
  • Health Informatics

Background:

  • Frailty is a significant predictor of adverse post-operative outcomes in elderly patients.
  • Existing frailty screening methods are resource-intensive, hindering widespread adoption.
  • There is a need for efficient, large-scale pre-operative frailty assessment tools.

Purpose of the Study:

  • To assess the association between an automated electronic frailty index (eFI) within the Electronic Health Record (EHR) and post-operative outcomes.
  • To determine the utility of an integrated EHR frailty measure for non-emergency surgeries in older adults.

Main Methods:

  • Retrospective cohort study involving patients aged 65 and older undergoing non-emergency surgery.
  • Utilized a 54-item electronic frailty index (eFI) derived from EHR data.
  • Analyzed outcomes including inpatient length of stay, post-acute care needs, 30-day readmission, and 6-month all-cause mortality.

Main Results:

  • Over 85% of patients had sufficient EHR data for eFI calculation; 15.1% were frail and 50.9% pre-frail.
  • Higher eFI scores correlated with increased risk for adverse outcomes.
  • Frail patients, compared to fit patients, showed significantly higher odds of requiring post-acute care (OR=1.68), 30-day readmission (HR=2.46), and 6-month mortality (HR=2.86) after adjusting for covariates.

Conclusions:

  • The electronic frailty index (eFI) serves as an effective, automated digital marker for frailty.
  • Integration of the eFI within EHR systems facilitates scalable pre-operative frailty screening.
  • This approach can aid in identifying high-risk older surgical patients for targeted interventions.