Nav: Home

Tool for identifying frail patients to reduce surgical risk works in health system setting

March 02, 2020

PITTSBURGH, March 2, 2020 - Frail patients in private-sector, multi-hospital health systems may benefit from a tool that can quickly predict their risk for poor outcomes following surgery, including postoperative mortality, readmission and extended hospital stays.

New research from UPMC -- published recently in the Annals of Surgery -- demonstrated that this prospective assessment index, which was previously validated in the VA Health System, was effectively implemented at scale in UPMC's diverse environment, requiring only 30 seconds per patient to accurately stratify patients for frailty.

Initially developed by the VA eight years ago, the so-called Risk Analysis Index (RAI) has been shown to accurately classify a patient's frailty and to predict their risk for adverse health consequences following surgery and other procedures. Until now, however, questions remained about the feasibility of implementing the index within complex, multi-hospital systems and the validity of the scores in a non-veteran population.

"Previous studies have shown that frail patients are at higher risk for poor outcomes after surgery, and our recent research shows that even procedures that physicians typically consider 'low risk' result in a higher rate of adverse events for frail patients," said Daniel Hall, M.D., corresponding author of the study and associate professor of surgery, University of Pittsburgh School of Medicine. "We want to ensure that all patients have the best outcomes possible based on their unique health factors. Validating the RAI in UPMC's large-scale clinical environment is a step toward that goal and provides a roadmap for other health systems."

The RAI uses a variety of clinical and patient-reported factors, such as age, gender, appetite, chronic health conditions and daily activity levels to generate a score representing each patient's level of frailty. Hall and his team implemented the RAI as a patient-facing questionnaire, integrating the tool into the electronic health record at UPMC surgical practices in Pittsburgh.

From July 1 to Dec. 31, 2016, 42,738 RAI assessments were completed for 36,261 patients across five surgical clinics -- or 77% of eligible patients within the first six months. Among this sample and compared to patients with "normal" RAI scores, patients considered "very frail" suffered five times the rate of death, three times the rate of readmission and 10 times the rate of extended hospital stays.

"This represents the largest reported cohort of patients with prospectively measured frailty within a clinical setting," said Hall, who also is medical director of the Wolff Center at UPMC, the health system's multi-disciplinary quality improvement center.

More importantly, he noted, his team demonstrated that the RAI has value as a broad screening instrument -- regardless of the patient's gender -- because it does not require the dedicated expertise of specific providers, disruption to the clinical workflow or additional clinic time beyond the initial surgical visit.

"With the silver tsunami of aging boomers, accurate and rapid risk stratification will be increasingly essential to ensure that surgical treatment is offered to the right patients and consistent with older patients' goals and values," said Hall. "Clinicians worried about the burden of frailty assessment used to ask, 'How can I afford to measure frailty?' However, these data demand a different question: 'How can I afford NOT to measure frailty?"
-end-
Further study is needed to show that interventions based on this information translate to improved outcomes or lower costs.

This research was supported by UPMC. Additional authors include Patrick R. Varley, M.D., of Pitt; Jeffrey D. Borrebach, M.S., Andrew L. Bilderback, M.S., Jonas T. Johnson, M.D., Joel B. Nelson, M.D., and Mary Kay Wisniewski, M.T., all of UPMC; Shipra Arya, M.D., of Stanford University; Nader N. Massarweh, M.D., M.P.H., of Baylor College of Medicine; and Jason M. Johanning, M.D., of the University of Nebraska Medical Center.

To read this release online or share it, visit https://www.upmc.com/media/news/030220-hall-rai.

About UPMC

A $21 billion health care provider and insurer, Pittsburgh-based UPMC is inventing new models of patient-centered, cost-effective, accountable care. The largest nongovernmental employer in Pennsylvania, UPMC integrates 89,000 employees, 40 hospitals, 700 doctors' offices and outpatient sites, and a more than 3.7 million-member Insurance Services Division, the largest medical insurer in western Pennsylvania. In the most recent fiscal year, UPMC contributed $1.2 billion in benefits to its communities, including more care to the region's most vulnerable citizens than any other health care institution, and paid $587 million in federal, state and local taxes. Working in close collaboration with the University of Pittsburgh Schools of the Health Sciences, UPMC shares its clinical, managerial and technological skills worldwide through its innovation and commercialization arm, UPMC Enterprises, and through UPMC International. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside on its annual Honor Roll of America's Best Hospitals and ranks UPMC Children's Hospital of Pittsburgh on its Honor Roll of America's Best Children's Hospitals. For more information, go to UPMC.com.

http://www.upmc.com/media

Contact: Courtney Caprara
Office: 412-647-6190
Mobile: 412-592-8134
E-mail: CapraraCL@upmc.edu

Contact: Wendy Zellner
Office: 412-586-9777
Mobile: 412-973-7266
Email: ZellnerWL@upmc.edu

University of Pittsburgh

Related Surgery Articles:

Examining association between weight loss before bariatric surgery, risk of death after surgery
Researchers looked at whether a patient's body weight and weight loss before bariatric surgery were associated with risk of death within 30 days after surgery using data from nearly 500,000 patients in the US and Canada.
Guidelines for thyroid surgery published in Annals of Surgery
The first set of comprehensive, evidence-based clinical guidelines for surgical treatment of thyroid disease -- developed by an expert panel assembled by the American Association of Endocrine Surgeons (AAES) -- was published today by Annals of Surgery.
Colorectal surgery patients use fewer opioids, report less pain with enhanced recovery after surgery
Colorectal surgery patients who were a part of an enhanced recovery after surgery (ERAS) program had less pain, while using nearly half as many opioids, according to research being presented at the ANESTHESIOLOGY® 2019 annual meeting.
Video assisted lung surgery reduces complications and hospital stays compared to open surgery
Video-assisted thoracic surgery is associated with lower in-hospital complications and shorter length of stay compared with open surgery among British patients who were diagnosed at an early stage of lung cancer, according to research presented today the IASLC 2019 World Conference on Lung Cancer, hosted by the International Association for the Study of Lung Cancer.
Most deaths related to noncardiac surgery occur after surgery and after discharge from hospital
It's not the operating room that is risky for patients undergoing noncardiac surgery; it's the recovery period.
Study looks at opioid use after knee surgery
A small study looked at whether reducing the number of opioid tablets prescribed after knee surgery would reduce postoperative use and if preoperative opioid-use education would reduce it even more.
Surgery patients are getting older every year
A new BJS (British Journal of Surgery) analysis reveals that people undergoing surgery in England are getting older at a faster rate than the general population.
Children requiring thyroid surgery have better outcomes at high-volume surgery centers
New research recently published in the Journal of Pediatric Surgery found that post-operative success rates of pediatric thyroid patients, particularly children who require a thyroidectomy, correlate with the institution's patient volume.
Do negative public attitudes toward weight loss surgery stop some patients from having surgery?
Most patients who qualify for weight loss surgery don't have the procedure despite its safety and effectiveness.
For spinal fusion surgery patients, taking opioids before surgery is major risk factor for long-term opioid use
Patients taking opioids for at least three months before spinal fusion surgery in the lower spine are much more likely to continue taking opioids one year after surgery, reports a study in Spine.
More Surgery News and Surgery Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.