Preoperative Frailty Increases Risk of Nonhome Discharge after Elective Vascular Surgery in Home-Dwelling Patients.
BACKGROUND
Patient-centered quality outcomes such as disposition after surgery are increasingly being scrutinized. Preoperative factors predictive of nonhome discharge (DC) may identify at-risk patients for targeted interventions. This study examines the association among preoperative risk factors, frailty, and nonhome DC after elective vascular surgery procedures in patients living at home.


METHODS
The 2011-2012 National Surgical Quality Improvement Project database was queried to identify all home-dwelling patients who underwent elective vascular procedures (endovascular and open aortic aneurysm repair, suprainguinal and infrainguinal bypasses, peripheral endovascular interventions, carotid endarterectomy, and stent). Preoperative frailty was measured using the modified frailty index (mFI; derived from Canadian Study of Health and Aging). Univariate and multivariate logistic regression analysis was performed to examine the association of frailty and nonhome DC.


RESULTS
Of 15,843 home-dwelling patients, 1,177 patients (7.4%) did not return home postoperatively. Frailty (mFI > 0.25) conferred a significantly increased 2-fold risk of nonhome DC disposition for each procedure type. Frailty, female gender, open procedures, increasing age, end-stage renal disease, and occurrence of any postoperative complication were associated with increased risk of nonhome DC. On multivariate logistic regression analysis, frailty increased the odds of nonhome DC by 60% (odds ratio 1.6, 95% confidence interval 1.4-1.8) after adjusting for other covariates. In the presence of complications, the risk of nonhome DC was 27.5% in frail versus 16.5% in nonfrail patients (P < 0.001). In the absence of complications, although absolute risk was lower, frail patients were nearly twice as likely to not return home (frail 5.5% vs. nonfrail 2.75%, P < 0.001).


CONCLUSIONS
Frail home-dwelling patients undergoing elective vascular procedures are at high risk of not returning home after surgery. Preoperative frailty assessment appears to hold potential for counseling regarding postsurgery disposition and DC planning.
Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Surgical Service Line, Atlanta VA Medical Center, Decatur, GA. Electronic address: shipra.arya@emory.edu.
Shipra
S
Arya
Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Chandler A
CA
Long
Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Reshma
R
Brahmbhatt
Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Susan
S
Shafii
Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Surgical Service Line, Atlanta VA Medical Center, Decatur, GA.
Luke P
LP
Brewster
Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
Ravi
R
Veeraswamy
Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine.
Theodore M
TM
Johnson
Division of Vascular Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
Jason M
JM
Johanning
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002170:Canada; D016009:Chi-Square Distribution; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D057187:Independent Living; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D010360:Patient Transfer; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012307:Risk Factors; D012866:Skilled Nursing Facilities; D016896:Treatment Outcome; D014481:United States; D014652:Vascular Diseases / Q000175:diagnosis / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*