PITTSBURGH, Feb. 22, 2023 – New research published today in JAMA Surgery shows that when frail patients are connected to resources, including conversations with a physician about possible outcomes and help preparing their body for surgery, they are less likely to die one year after surgery.
While age can be an important indicator of a patient’s likelihood of encountering adverse outcomes or complications of surgery, it does not provide a full picture of their health. Frailty considers the patient’s overall well-being, including their physical and cognitive abilities, as well as their body’s ability to recover from surgery.
“Frailty is a particularly strong predictor of postoperative outcomes,” said Daniel Hall, M.D. , corresponding author of the study and associate professor of surgery at the University of Pittsburgh School of Medicine . “Frailty can be thought of as having low physiologic reserve. Surgeries and other stressors can deplete this reserve, potentially leading to catastrophic outcomes like loss of independence or death.”
The study looked at over 50,000 patients across five UPMC hospitals who were scheduled to undergo a major surgery. Before meeting their surgeons, patients completed a brief survey to assess frailty, and a medical assistant entered the score into the electronic health record. For the 1,300 patients who met the criteria to be considered frail, the record prompted the surgeon to either have another conversation with the patient about possible frailty-associated adverse outcomes of the procedure or direct the patient to other resources, such as their primary care physician or UPMC’s Center for Perioperative Care .
After following these patients for a year, Hall and his team discovered that patients who were identified as frail and connected to any additional resources were 18% less likely to die one year after their surgery.
One explanation for this reduction in risk is that patients took advantage of these resources to make healthy lifestyle changes, such as managing their weight or quitting smoking. Another explanation is that some patients who discussed possible adverse outcomes with a physician may have chosen not to proceed with their surgery.
“As clinicians, we sometimes make the general assumption that that which can be done, should be done,” Hall said. “By discussing the possible adverse outcomes with their doctor, patients may choose a nonoperative management strategy to get their condition under control without the possible risks of surgery. This intervention allows for better goal clarification, better alignment of treatment plans with patient goals and better shared decision -making.”
Further studies are needed to determine which interventions have the biggest impact on patient outcomes, as well as how to adapt these screenings to other practice settings.
This research was supported by UPMC. Additional authors include Patrick V. Varley, M.D., University of Wisconsin School of Medicine and Public Health, Dan Buchanan, M.S., Andrew Bilderback, M.S., Mary Kay Wisniewski, M.T., Tamara Minnier, M.S.N., all of the Wolff Center at UPMC , Jason Johanning, M.D., University of Nebraska Medical Center, Joel B. Nelson, M.D., and Jonas T. Johnson, M.D., both of the University of Pittsburgh School of Medicine .
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About the University of Pittsburgh School of Medicine
As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top recipients of funding from the National Institutes of Health since 1998. In rankings released by the National Science Foundation, Pitt is in the upper echelon of all American universities in total federal science and engineering research and development support.
Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC , which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see www.medschool.pitt.edu .
JAMA Surgery
22-Feb-2023