| Abstrakt: |
Introduction:Frailty results in decreased capacity to respond to physiologic stress, increasing risk of adverse outcomes following surgery. There is no standard tool for quantifying frailty in the pre-operative setting; available screening tools are resource intensive and typically focus on comorbidity. Many patients who undergo Coronary Artery Bypass Grafting (CABG) are medically frail. The electronic Frailty Index (eFI), based on the theory of deficit accumulation, is an automated score embedded in the electronic health record (EHR) at our institution that integrates 54 deficits assessing outpatient vital signs and labs, comorbidity, polypharmacy, and functional status. This study aims to assess the clinical utility of the eFI in preoperative risk stratification among patients who underwent CABG.Methods:Single institution, retrospective cohort study of patients that underwent CABG from January 2017 to July 2020. Exclusion criteria included patients with insufficient pre-operative EHR data for the eFI, INR >1.5, total bilirubin >2, and CABG >5 days after admission. Outcomes included length of stay (LOS) and discharge destination (home vs acute care facility). Patients’ eFI score prior to surgery was classified as fit (0-0.10), pre-frail (>0.10-0.21), or frail (>0.21). Data were analyzed using multivariable linear regression and area under the curve.Results:414 patients, mean age = 68.7 (SD 7.4) years, underwent CABG, with 49.3% categorized at pre-frail and 30.2% as frail. Both mean LOS (fit 7.0 days, pre-frail 7.3 days, frail 9.7 days) and the likelihood of being discharged to an acute care facility (fit 21.6%, pre-frail 19.6%, frail 34.1%) were increased for patients classified as frail. The eFI was the only variable we considered that was associated with LOS (p=0.006), while both age (p<0.001) and the eFI (p=0.005) were associated with discharge location. Adding the eFI to a classifier based on age and sex improved the AUC from 0.627 to 0.671 for LOS < 6 days vs >6 days, and from 0.675 to 0.695 for discharge destination.Conclusions:The eFI was a strong predictor of LOS and discharge to an acute care facility after CABG. Automated tools such as the eFI should be considered preoperatively when discussing potential revascularization options. |
