Dataset Information

Predicting hospital outcomes with the reported edmonton frail scale-Thai version in orthopaedic older patients.

ABSTRACT:

Aims and objectives

To test the ability of the Reported Edmonton Frail Scale-Thai version to predict hospital outcomes compared with standard preoperative assessment measures (American Society of Anesthesiologists physical status classification and the Elixhauser Comorbidity Measure) in older Thai orthopaedic patients.

Background

Frailty is a common geriatric condition. No previous studies have assessed frailty among orthopaedic patients in Thailand. Effective frailty screening could enhance quality of care.

Design

Prospective cohort study in a university hospital.

Methods

Two hundred hospitalised patients, aged 60 years or older and scheduled for orthopaedic surgery, participated in the study. Frailty was evaluated using the Reported Edmonton Frail Scale-Thai version. Multiple Firth logistic regression was used to model the effect of frailty on postoperative complications, postoperative delirium and discharge disposition. Length of stay was examined using Poisson regression. Comparing predictability of the instruments, the area under the receiver operating characteristic curve and mean squared errors were evaluated. The STROBE guideline was used.

Results

Participants' mean age was 72 years; mostly were female, frail and underwent knee, spine and/or hip surgery. Poor health outcomes including postoperative complications, postoperative delirium, and not being discharged to the home were commonly identified. The length of stay varied from three days to more than ten weeks. Frailty was significantly associated with postoperative complications, postoperative delirium and prolonged length of stay. The Reported Edmonton Frail Scale-Thai version revealed good performance for predicting postoperative complications and postoperative delirium and was improved by combining with standard assessments.

Conclusion

The Reported Edmonton Frail Scale-Thai version, alone or combined with standard assessment, was useful for predicting adverse outcomes in older adults undergoing orthopaedic surgery.

Relevance to clinical practice

These findings indicate that nurse professionals should apply culturally sensitive frailty screening to proactively identify patients' risk of frailty, improve care quality and prevent adverse outcomes.

SUBMITTER: Roopsawang I

PROVIDER: S-EPMC7756727 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Predicting hospital outcomes with the reported edmonton frail scale-Thai version in orthopaedic older patients.

Roopsawang Inthira I Thompson Hilaire H Zaslavsky Oleg O Belza Basia B

Journal of clinical nursing 20201011 23-24

<h4>Aims and objectives</h4>To test the ability of the Reported Edmonton Frail Scale-Thai version to predict hospital outcomes compared with standard preoperative assessment measures (American Society of Anesthesiologists physical status classification and the Elixhauser Comorbidity Measure) in older Thai orthopaedic patients.<h4>Background</h4>Frailty is a common geriatric condition. No previous studies have assessed frailty among orthopaedic patients in Thailand. Effective frailty screening co ...[more]

PMID: 32981142

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Project description:BackgroundSeveral screening tools are developed to identify frailty in the increasing number of older patients with cancer. Edmonton Frail Scale (EFS) performs well in geriatric settings but is less studied in oncology. We aimed to investigate if EFS score (continuous and categorical) predicts survival in patients referred for radiotherapy, and to assess the concurrent validity of EFS compared with a modified geriatric assessment (mGA).MethodsProspective observational, single-center study including patients ≥65 years, referred for curative or palliative radiotherapy for confirmed cancer. Patients underwent mGA (assessment of cognition, mobility, falls, comorbidity, polypharmacy, depression, nutrition, and activities of daily living) and screening with EFS prior to radiotherapy. The predictive value of EFS score of two-year overall survival (OS) was assessed by Kaplan-Meier plots and compared by log-rank test. Cox proportional hazards regression model was estimated to adjust the associations for major cancer-related factors. Concurrent validity of EFS in relation to mGA was estimated by Spearman`s correlation coefficient and ordinal regression. Sensitivity and specificity for different cut-offs was assessed.ResultsPatients' (n = 301) mean age was 73.6 (SD 6.3) years, 159 (52.8%) were men, 54% received curative-intent treatment, breast cancer (32%) was the most prevalent diagnosis. According to EFS≥6, 101 (33.7%) were classified as frail. EFS score was predictive of OS [hazard ratio (HR) 1.20 (95% confidence interval (CI) 1.10-1.30)], as was increasing severity assessed by categorical EFS (p<0.001). There was a strong correlation between EFS score and number of geriatric impairments (Spearman`s correlation coefficient 0.77). EFS cut-off ≥6 had a sensitivity of 0.97 and specificity of 0.57 for identifying patients with minimum two geriatric impairments.ConclusionEFS predicts mortality in older patients with cancer receiving radiotherapy, and it is a quick (<5 minutes) and sensitive screening tool to identify patients who may benefit from a geriatric assessment.

Project description:BackgroundFrailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality.MaterialsTwo cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR.MethodsKaplan-Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0-05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years.ResultsFrailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29-0.66)), age (1.05 (1.01-1.09)), weight (0.98 (0.96-1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41-0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33-0.74)), SPPB sit and stand (0.62 (0.45-0.85)), heart failure (0.67 (0.46-0.98)), use of antiplatelets (1.80 (1.19-2.71)), and quetiapine (0.31 (0.12-0.81)). Specific high-risk factors in the pre-frail cohort are Barthel's score (120 (7.7-1700)), Pfeiffer test (8.4; (2.3-31)), Mini Nutritional Assessment (MNA) (1200 (18-88,000)), constipation (0.025 (0.0027-0.24)), falls (18,000 (150-2,200,000)), deep venous thrombosis (8400 (19-3,700,000)), cerebrovascular disease (0.01 (0.00064-0.16)), diabetes (360 (3.4-39,000)), thyroid disease (0.00099 (0.000012-0.085)), and the use of PPIs (0.062 (0.0072-0.54)), Zolpidem (0.000014 (0.0000000021-0.092)), antidiabetics (0.00015 (0.00000042-0.051)), diuretics (0.0003 (0.000004-0.022)), and opiates (0.000069 (0.00000035-0.013)).ConclusionsFrailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.

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Dataset Information

Predicting hospital outcomes with the reported edmonton frail scale-Thai version in orthopaedic older patients.

Aims and objectives

Background

Design

Methods

Results

Conclusion

Relevance to clinical practice

Publications

Predicting hospital outcomes with the reported edmonton frail scale-Thai version in orthopaedic older patients.

Similar Datasets

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