Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;69(5):1357-1362.
doi: 10.1111/jgs.17027. Epub 2021 Jan 19.

Automated Frailty Screening At-Scale for Pre-Operative Risk Stratification Using the Electronic Frailty Index

Kathryn E Callahan  1   2 , Clancy J Clark  2   3 , Angela F Edwards  4 , Timothy N Harwood  4 , Jeff D Williamson  1   2 , Adam W Moses  2   5 , James J Willard  2   6 , Joseph A Cristiano  5 , Kellice Meadows  7 , Justin Hurie  8 , Kevin P High  2   9 , J Wayne Meredith  7 , Nicholas M Pajewski  2   6
Affiliations

Automated Frailty Screening At-Scale for Pre-Operative Risk Stratification Using the Electronic Frailty Index

Kathryn E Callahan et al. J Am Geriatr Soc. 2021 May.

Abstract

Background: Frailty is associated with numerous post-operative adverse outcomes in older adults. Current pre-operative frailty screening tools require additional data collection or objective assessments, adding expense and limiting large-scale implementation.

Objective: To evaluate the association of an automated measure of frailty integrated within the Electronic Health Record (EHR) with post-operative outcomes for nonemergency surgeries.

Design: Retrospective cohort study.

Setting: Academic Medical Center.

Participants: Patients 65 years or older that underwent nonemergency surgery with an inpatient stay 24 hours or more between October 8th, 2017 and June 1st, 2019.

Exposures: Frailty as measured by a 54-item electronic frailty index (eFI).

Outcomes and measurements: Inpatient length of stay, requirements for post-acute care, 30-day readmission, and 6-month all-cause mortality.

Results: Of 4,831 unique patients (2,281 females (47.3%); mean (SD) age, 73.2 (5.9) years), 4,143 (85.7%) had sufficient EHR data to calculate the eFI, with 15.1% categorized as frail (eFI > 0.21) and 50.9% pre-frail (0.10 < eFI ≤ 0.21). For all outcomes, there was a generally a gradation of risk with higher eFI scores. For example, adjusting for age, sex, race/ethnicity, and American Society of Anesthesiologists class, and accounting for variability by service line, patients identified as frail based on the eFI, compared to fit patients, had greater needs for post-acute care (odds ratio (OR) = 1.68; 95% confidence interval (CI) = 1.36-2.08), higher rates of 30-day readmission (hazard ratio (HR) = 2.46; 95%CI = 1.72-3.52) and higher all-cause mortality (HR = 2.86; 95%CI = 1.84-4.44) over 6 months' follow-up.

Conclusions: The eFI, an automated digital marker for frailty integrated within the EHR, can facilitate pre-operative frailty screening at scale.

Keywords: frailty; healthcare utilization; preoperative assessment.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors have no conflicts.

Figures

Figure 1.
Figure 1.
All-cause mortality after surgery by frailty status based on the electronic Frailty Index (eFI). Frailty status defined as Fit (eFI ≤ 0.10), Pre-Frail (0.10 < eFI ≤ 0.21), or Frail (eFI > 0.21). Shaded areas denote 95% pointwise confidence intervals.
See this image and copyright information in PMC

References

    1. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A Biol Sci Med Sci. 2001;56(3):M146–M157. 10.1093/gerona/56.3.m146. - DOI - PubMed
    1. Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–908. 10.1016/j.jamcollsurg.2010.01.028. - DOI - PubMed
    1. Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2001;1:323–336. 10.1100/tsw.2001.58. - DOI - PMC - PubMed
    1. Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol Ser A Biol Sci Med Sci. 2007;62(7):722–727. 10.1093/gerona/62.7.722. - DOI - PubMed
    1. Tyrrell DJ, Bharadwaj MS, Jorgensen MJ, Register TC, Molina AJA. Blood cell respirometry is associated with skeletal and cardiac muscle bioenergetics: implications for a minimally invasive biomarker of mitochondrial health. Redox Biol. 2016;10:65–77. 10.1016/j.redox.2016.09.009. - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources