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. 2023 Nov;89(11):4501-4507.
doi: 10.1177/00031348221121547. Epub 2022 Aug 16.

Automated Electronic Frailty Index is Associated with Non-home Discharge in Patients Undergoing Open Revascularization for Peripheral Vascular Disease

Ashlee E Stutsrim  1 , Ian M Brastauskas  1 , Tim E Craven  2 , Kathryn E Callahan  3 , Nicholas M Pajewski  2 , Ross P Davis  1 , Matthew A Corriere  4 , Matthew S Edwards  1 , Matthew P Goldman  1
Affiliations

Automated Electronic Frailty Index is Associated with Non-home Discharge in Patients Undergoing Open Revascularization for Peripheral Vascular Disease

Ashlee E Stutsrim et al. Am Surg. 2023 Nov.

Abstract

Background: Frailty is associated with adverse surgical outcomes including post-operative complications, needs for post-acute care, and mortality. While multiple frailty screening tools exist, most are time and resource intensive. Here we examine the association of an automated electronic frailty index (eFI), derived from routine data in the Electronic Health Record (EHR), with outcomes in vascular surgery patients undergoing open, lower extremity revascularization.

Methods: A retrospective analysis at a single academic medical center from 2015 to 2019 was completed. Information extracted from the EHR included demographics, eFI, comorbidity, and procedure type. Frailty status was defined as fit (eFI≤0.10), pre-frail (0.10<eFI≤0.21), and frail (eFI>0.21). Outcomes included length of stay (LOS), 30-day readmission, and non-home discharge.

Results: We included 295 patients (mean age 65.9 years; 31% female), with the majority classified as pre-frail (57%) or frail (32%). Frail patients exhibited a higher degree of comorbidity and were more likely to be classified as American Society of Anesthesiologist class IV (frail: 46%, pre-frail: 27%, and fit: 18%, P = 0.0012). There were no statistically significant differences in procedure type, LOS, or 30-day readmissions based on eFI. Frail patients were more likely to expire in the hospital or be discharged to an acute care facility (31%) compared to pre-frail (14%) and fit patients (15%, P = 0.002). Adjusting for comorbidity, risk of non-home discharge was higher comparing frail to pre-frail patients (OR 3.01, 95% CI 1.40-6.48).

Discussion: Frail patients, based on eFI, undergoing elective, open, lower extremity revascularization were twice as likely to not be discharged home.

Keywords: geriatrics; special topics; vascular surgery.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Odds ratios of non-home discharge with 95% confidence limits for eFI groups estimated from logistic regression models. ORs are shown for models that include age, gender, race, ASA class, and procedure type only (left); and those covariates with Charlson Comorbidity Index added (right).
See this image and copyright information in PMC

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