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. 2023 Nov 1;6(11):e2341915.
doi: 10.1001/jamanetworkopen.2023.41915.

Automated Electronic Frailty Index-Identified Frailty Status and Associated Postsurgical Adverse Events

Ashish K Khanna  1   2   3 , Vida Motamedi  1   3   4 , Bethany Bouldin  1   3 , Timothy Harwood  1 , Nicholas M Pajewski  5 , Amit K Saha  1   2 , Scott Segal  1   2
Affiliations

Automated Electronic Frailty Index-Identified Frailty Status and Associated Postsurgical Adverse Events

Ashish K Khanna et al. JAMA Netw Open. .

Abstract

Importance: Electronic frailty index (eFI) is an automated electronic health record (EHR)-based tool that uses a combination of clinical encounters, diagnosis codes, laboratory workups, medications, and Medicare annual wellness visit data as markers of frailty status. The association of eFI with postanesthesia adverse outcomes has not been evaluated.

Objective: To examine the association of frailty, calculated as eFI at the time of the surgical procedure and categorized as fit, prefrail, or frail, with adverse events after elective noncardiac surgery.

Design, setting, and participants: This cohort study was conducted at a tertiary care academic medical center in Winston-Salem, North Carolina. The cohort included patients 55 years or older who underwent noncardiac surgery of at least 1 hour in duration between October 1, 2017, and June 30, 2021.

Exposure: Frailty calculated by the eFI tool. Preoperative eFI scores were calculated based on available data 1 day prior to the procedure and categorized as fit (eFI score: ≤0.10), prefrail (eFI score: >0.10 to ≤0.21), or frail (eFI score: >0.21).

Main outcomes and measures: The primary outcome was a composite of the following 8 adverse component events: 90-item Patient Safety Indicators (PSI 90) score, hospital-acquired conditions, in-hospital mortality, 30-day mortality, 30-day readmission, 30-day emergency department visit after surgery, transfer to a skilled nursing facility after surgery, or unexpected intensive care unit admission after surgery. Secondary outcomes were each of the component events of the composite.

Results: Of the 33 449 patients (median [IQR] age, 67 [61-74] years; 17 618 females [52.7%]) included, 11 563 (34.6%) were classified as fit, 15 928 (47.6%) as prefrail, and 5958 (17.8%) as frail. Using logistic regression models that were adjusted for age, sex, race and ethnicity, and comorbidity burden, patients with prefrail (odds ratio [OR], 1.24; 95% CI, 1.18-1.30; P < .001) and frail (OR, 1.71; 95% CI, 1.58-1.82; P < .001) statuses were more likely to experience postoperative adverse events compared with patients with a fit status. Subsequent adjustment for all other potential confounders or covariates did not alter this association. For every increase in eFI of 0.03 units, the odds of a composite of postoperative adverse events increased by 1.06 (95% CI, 1.03-1.13; P < .001).

Conclusions and relevance: This cohort study found that frailty, as measured by an automatically calculated index integrated within the EHR, was associated with increased risk of adverse events after noncardiac surgery. Deployment of eFI tools may support screening and possible risk modification, especially in patients who undergo high-risk surgery.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Khanna reported receiving grants from Edwards Lifesciences; Retia Medical; Caretaker Medical; Potrero Medical; Trevena Pharma; US Department of Defense; Biomedical Advanced Research and Development Authority and National Heart, Lung, and Blood Institute; Canadian Institute of Healthcare Research; Rediscovery Lifesciences; Rehabtronics Inc; and Daxor Inc and personal fees from Edwards Lifesciences, GE Healthcare, Philips Research North America, Retia Medical, Caretaker Medical, Potrero Medical, Trevena Pharma, and Medtronic outside the submitted work. Dr Pajewski reported receiving grants from National Institute on Aging during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Varying Risk of Study Outcome for Electronic Frailty Index Groups After Adjustment for All Potential Confounders and Covariates
ED indicates emergency department; HAC, hospital-acquired condition; ICU, intensive care unit; OR, odds ratio; PSI 90, 90-item Patient Safety Indicators; and SNF, skilled nursing facility.
See this image and copyright information in PMC

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