Frailty and Survival for Diagnoses Feasibly Managed Operatively or Nonoperatively.

Area of Science:

• Geriatric Surgery
• Health Services Research
• Comparative Effectiveness

Background:

• A surgical pause improves outcomes for frail patients, but nonoperative management outcomes are unknown.
• Frailty significantly impacts patient outcomes in surgical and nonoperative settings.
• Understanding frailty-specific outcomes is crucial for optimizing treatment strategies.

Purpose of the Study:

• To compare outcomes of operative versus nonoperative management for eight common conditions, stratified by frailty.
• To evaluate the impact of frailty on survival, hospital-free days, and discharge disposition.
• To identify optimal management strategies based on patient frailty levels.

Main Methods:

• Observational cohort study of 49,169 adult patients from 2016-2023 across a multi-hospital system.
• Landmarked analysis comparing 2-year survival and 365-day hospital-free days (HFD-365) by management strategy and frailty category (using Risk Analysis Index).
• Secondary analysis of postoperative length of stay and discharge disposition.

Main Results:

• Operative management was associated with lower mortality overall (1.3% vs 2.5%) and in most frailty categories, except the very frail (8.1% vs 12.1%).
• Operative management yielded more HFD-365, particularly for the very frail (median 365 vs 361 days).
• Frailty was linked to longer postoperative stays and fewer discharges home (OR=2.0).

Conclusions:

• Nonoperative management may be preferred for very frail patients due to protracted postoperative recovery.
• Management decisions should consider individual frailty status for these eight clinical conditions.
• Further research into frailty-specific treatment pathways is warranted.