The Use of Frailty Scores for Screening the Surgical Risk Benefits: A Multidisciplinary Approach.

Autor:	Ballacchino MM; Medical Student (MS3), University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, 955 Main St, Buffalo, NY 14203, U.S.A., McQuestion CC; Medical Student (MS2), University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, 955 Main St, Buffalo, NY 14203, U.S.A., Giuca MS; Assistant Professor of Anesthesiology, State University of New York Downstate, Northport VA Medical Center, 101 Nicolls Road Health Sciences Center, Stony Brook, NY 11794-8434, U.S.A., Dosluoglu HH; Professor of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, 955 Main St, Buffalo, NY 14203, U.S.A., Nader ND; Professor of Anesthesiology & Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, 955 Main St, Buffalo, NY 14203, U.S.A.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Jul 23. Date of Electronic Publication: 2024 Jul 23.
DOI:	10.1097/SLA.0000000000006452
Abstrakt:	Objective: Our study aims to examine the role of multi-disciplinary surgical pause committees (MDSPC) in perioperative planning to reduce adverse postoperative events and mortality rates. Summary Background Data: Frail patients could benefit from preoperative MDSPCs when utilizing risk-benefit ratios for the proposed surgical plan. We examined whether MDSPCs improved clinical outcomes by developing individualized care plans and stratifying patients based on their level of frailty and ability to overcome external stressors. Methods: We retrospectively collected patient information after MDSPC evaluation, at our medical center for 12 years since 2011. Patient's frailty risk assessment index (RAI) scores were calculated, and survival status was updated. MDSPCs plans were put into the following categories: proceed with the planned surgery (G1), proceed after medical optimization (G2), reduce invasiveness of surgery or anesthesia plan (G3), or adopt a non-surgical approach (G4). Chi-square and independent t-tests were used for categorical and numerical data, respectively. Survival analysis for 30-day (primary endpoint), one-year, and overall mortality rates used Kaplan-Meier. The alpha was set at 0.05. Results: Clinical information was accessed from 12 women and 382 men. The average age was 71±11 years. 87.3% of planned surgical operations were stratified as ASA class III and IV. RAI scores were 36.4±9.6 (G1), similar to 37.4±10.8 (G2) but lower than 41.4±9.3 (G3) and 44.2±9.7 (G4) (P<0.001). Average survival duration was 35 months (G1), 35 months (G2), both significantly longer than 20 months (G3) and 18 months (G4) (P<0.001). Conclusion: Medical optimization improved overall survival and reduced death within 30 days and one year to be comparable to G1. Additionally, reducing the surgical invasiveness only improved survival advantage for six months, after which it was comparable to those in G4 with the worst outcome. RAI scoring is an excellent tool to predict the outcome of surgery, and it was used successfully in critically ill patients. Competing Interests: Disclosures: The authors involved have no financial, consultant, institutional, or other relationship conflicts of interest to disclose. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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