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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.
Background:
Frailty is associated with numerous post-operative adverse outcomes in older adults. Current pre-operative frailty screening tools require additional data collection or objective assessments, adding expense and limiting large-scale implementation.
Objective:
To evaluate the association of an automated measure of frailty integrated within the Electronic Health Record (EHR) with post-operative outcomes for nonemergency surgeries.
Design:
Retrospective cohort study.
Setting:
Academic Medical Center.
Participants:
Patients 65 years or older that underwent nonemergency surgery with an inpatient stay 24 hours or more between October 8th, 2017 and June 1st, 2019.
Exposures:
Frailty as measured by a 54-item electronic frailty index (eFI).
Outcomes And Measurements:
Inpatient length of stay, requirements for post-acute care, 30-day readmission, and 6-month all-cause mortality.
Results:
Of 4,831 unique patients (2,281 females (47.3%); mean (SD) age, 73.2 (5.9) years), 4,143 (85.7%) had sufficient EHR data to calculate the eFI, with 15.1% categorized as frail (eFI > 0.21) and 50.9% pre-frail (0.10 < eFI ≤ 0.21). For all outcomes, there was a generally a gradation of risk with higher eFI scores. For example, adjusting for age, sex, race/ethnicity, and American Society of Anesthesiologists class, and accounting for variability by service line, patients identified as frail based on the eFI, compared to fit patients, had greater needs for post-acute care (odds ratio (OR) = 1.68; 95% confidence interval (CI) = 1.36-2.08), higher rates of 30-day readmission (hazard ratio (HR) = 2.46; 95%CI = 1.72-3.52) and higher all-cause mortality (HR = 2.86; 95%CI = 1.84-4.44) over 6 months' follow-up.
Conclusions:
The eFI, an automated digital marker for frailty integrated within the EHR, can facilitate pre-operative frailty screening at scale.
