Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: Compare outcomes, stratified by frailty, of patients with eight common conditions with plausible operative and nonoperative management strategies. SUMMARY BACKGROUND DATA: A surgical pause, evaluating potential adverse outcomes among frail patients, improves postoperative outcomes; however, the outcomes among patients opting for nonoperative management are unknown. METHODS: In an observational cohort study across a multi-hospital healthcare system including adults presenting to outpatient surgical clinics (2016-2023) for evaluation of eight conditions feasibly managed operatively or nonoperatively as defined by modified Delphi consensus. In a landmarked analysis, we compared 2-year survival by management strategies across frailty categories (robust, normal, frail, very frail) as defined by the Risk Analysis Index (RAI). Secondarily we compared 365-day hospital free days (HFD-365), postoperative length of stay, and discharge disposition. RESULTS: Among 49,169 patients (mean±SD age, 60.4±14.6 y; 54.6% female), operative management was associated with lower observed and adjusted mortality (1.3% vs 2.5%; aHR=0.55 [95% CI, 0.47-0.66], P<0.0001) overall and among all frailty categories expect the very frail (8.1% vs 12.1%, P=0.1). Additionally, operative management was associated with fewer HFD-365 again overall which was specifically prominent among the very frail (median 365 [IQR, 358-365] vs 361 days [IQR, 357-363], P<0.0001). Postoperatively, frailty portended more protracted recoveries with greater postoperative lengths of stay (1.7±2.6 vs 1.2±2.1) days, P<0.0001) and fewer discharges home (370 [85.1%] vs 5,087 [91.8%], P<0.0001; odds ratio=2.0 [95%CI 1.5-2.6]). CONCLUSIONS: Considering the protracted postoperative recovery of very frail patients, nonoperative management might be the preferred treatment option for those presenting with these eight clinical conditions.
Source: Annals of Surgery
Authors: Emily Mosher, Hasan Nassereldine, Jeffrey C. McKibben, Jason Johanning, Shipra Arya, Nader N. Massarweh, Rupen Shah, Myrick Shinall, Paula Shireman, Patrick R. Varley, Elizabeth L. George, Ada Youk, Leah Backhus, Alaina J. Brown, Neil Christie, Rajeev Dhupar, Nicole Donnellan, Nicholas John Giori, Matthew R. Goede, Richard Guido, Joon Lee, Jennifer L. Griffin Miller, Justin C. Siebler, Daniel A. Tonetti, Scott A. Vincent, Katherine M. Reitz, Daniel E. Hall
Institutions: University of Pittsburgh, University of Pittsburgh Medical Center, Nebraska Medical Center, VA Nebraska Western Iowa Health Care System, University of Nebraska Medical Center, VA Palo Alto Health Care System, Stanford Medicine, Stanford University, Emory University, VA Pittsburgh Healthcare System, Atlanta VA Health Care System, Atlanta VA Medical Center, Henry Ford Health, Henry Ford Hospital, Vanderbilt University Medical Center, Texas A&M University, University of Wisconsin–Madison, Vanderbilt University, Cooper University Health Care, Morehouse School of Medicine, UPMC Health System
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4409870506