Comparing Hospital-Free Days by Frailty Status for Patients Undergoing Surgical Intervention for Cardiovascular...

Area of Science:

• Geriatric Surgery
• Patient Outcomes Research
• Health Services Research

Background:

• Aging populations present increased surgical complexity due to comorbidities like atherosclerotic cardiovascular diseases (ASCVD).
• Patient frailty is a significant predictor of adverse postoperative outcomes in surgical patients.
• Hospital free days (HFD) is a patient-centered metric quantifying time spent at home post-discharge.

Purpose of the Study:

• To assess the association between patient frailty and 90-day hospital free days (HFD-90).
• To evaluate the relationship between frailty and in-hospital mortality in surgical patients.
• To determine the utility of HFD-90 as a comprehensive outcome measure in frail surgical cohorts.

Main Methods:

• Retrospective analysis of 67,861 patients undergoing major cardiovascular surgeries (2015-2018) from the Florida State Inpatient Database.
• Frailty assessed using the Risk Analysis Index (RAI).
• Multivariable regression models (zero-inflated negative binomial and ordinal logistic) used to analyze HFD-90 and in-hospital mortality in relation to frailty status.

Main Results:

• Frail patients experienced significantly lower 90-day hospital free days (HFD-90) compared to normal patients (aRR=0.95).
• Frailty was strongly associated with a higher risk of in-hospital mortality (aOR=6.20) compared to robust or normal patients.
• Robust patients demonstrated increased HFD-90 (aRR=1.03) and decreased in-hospital mortality (aOR=0.40) compared to normal patients.

Conclusions:

• 90-day hospital free days (HFD-90) is a feasible and comprehensive patient-centered metric for evaluating surgical outcomes.
• HFD-90 effectively integrates key postoperative outcomes including mortality, length of stay, and readmission into a single measure.
• This metric is particularly valuable for assessing outcomes in frail surgical patient populations.