84.18 Frailty as a Predictor of Complications in Plastics

Posted on January 26, 2017

O. Trofymenko1, H. Aziz1, B. Joseph1  1University Of Arizona,General Surgery,Tucson, AZ, USA

Introduction:

Frailty has emerged as an important patient-specific characteristic that has been show to positively correlate with various surgical and medical complications encompassing a broad range of surgical practices.

Methods:
National Surgical Quality Improvement Program (NSQIP) was quarried to select all of the cased from 2011-2012 of non-emergency elective outpatient and inpatient plastic surgery procedures. The data was separated into inpatient and outpatient procedures and analyzed separately for each cohort. Modified frailty (mFI), previously described measure of frailty, was used as a proxy for frailty.

Results:
Out of 23,661 cases quarried, 63.48% (n=16,440) were inpatient and 30.52% (n=7,221) – outpatient. For outpatient cohort, 73.29% of patients had mFI of 0 (non-frail), 20.10% were ASA class 3 or above, 3.30% had postoperative complication(s), and 2.11% were readmitted within 30 days. For outpatient sample, 63.99% of patients were non-frail, 34.10% were ASA class 3 or above, 15.51% had postoperative complication(s), and 6.62% were readmitted within 30 days. On univariate analysis, higher mFI positively correlated with outpatient (p=0.017) and inpatient (p<0.001) overall complication rates; as well as outpatient (p<0.001) and inpatient (p<0.001) unplanned readmission rates. Multivariate CC model showed mFI to independently correlated with outpatient unplanned readmission rate (Odds Ratio (OR): 18.657; p=0.020) and inpatient overall complication rate (OR: 26.107; p=0.001). MICE model indicated mFI to be independently predictive of outpatient unplanned readmission rate (OR: 69.059; p<0.001), inpatient overall complications rate (OR: 28.553; p<0.001), and inpatient unplanned readmission rate (OR: 20.358; p=0.013).

Conclusion:
Our findings suggest that frailty, as a patient-specific characteristic, may add value to stratification of operative risks, preoperative planning, and implementation of a more effective post-operative management.