scholarly journals Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study

2018 ◽  
Vol 190 (7) ◽  
pp. E184-E190 ◽  
Author(s):  
Yibo Li ◽  
Jenelle L. Pederson ◽  
Thomas A. Churchill ◽  
Adrian S. Wagg ◽  
Jayna M. Holroyd-Leduc ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Surgical Patients

scholarly journals Prevalence of frailty and reliability of established frailty instruments in adult elective colorectal surgical patients: a prospective cohort study

2021 ◽  
pp. postgradmedj-2020-139417
Author(s):  
Thomas Dale MacLaine ◽  
Oliver Baker ◽  
Dermot Burke ◽  
Simon J Howell
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Large Population ◽  
Age Groups ◽  
Adverse Outcomes ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Frailty Phenotype

PurposeLarge population studies now demonstrate that frailty is prevalent in all adult age groups. Limited data exist on the association between frailty and surgical outcome in younger patients. The aim of the study was to explore the agreement between frailty identification tools and collect pilot data on their predictive value for frailty-associated outcomes in an adult surgical population.Study designProspective cohort study.ResultsFrailty scores were recorded in 200 patients (91 men), mean (range) age 57 (18–92) years. The prevalence of prefrailty was 52%–67% and that of frailty 2%–32% depending on the instrument used. Agreement between the instruments was poor, kappa 0.08–0.17 in pairwise comparisons. Outcome data were available on 160 patients. Only the frailty phenotype was significantly associated with adverse outcomes, RR 6.1 (1.5–24.5) for postoperative complications. The three frailty scoring instruments studies had good sensitivity (Clinical Frailty Scale (CFS)—90%, Accumulation Deficit (AD)—96%, Frailty Phenotype (FP)—97%) but poor specificity (CFS—12%, AD—13%, FP—18%) for the prediction of postoperative complications. All three instruments were poorly predictive of adverse outcomes with likelihood ratios of CFS—1.02, AD—1.09 and FP—1.17.ConclusionsThis study showed a significant prevalence of prefrailty and frailty in adult colorectal surgical patients of all ages. There was poor agreement between three established frailty scoring instruments. Our data do not support the use of current frailty scoring instruments in all adult colorectal surgical patients. However, the significant prevalence of prefrailty and frailty across all age groups of adult surgical patient justifies further research to refine frailty scoring in surgical patients.

scholarly journals Post-discharge opioid use and handling in surgical patients: A multicentre prospective cohort study

2020 ◽  
Vol 48 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Megan L Allen ◽  
Charles C Kim ◽  
Sabine Braat ◽  
Karin Jones ◽  
Noam Winter ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Surgical Patients ◽  
Opioid Use ◽  
Post Discharge ◽  
Opioid Medication ◽  
Post Surgery ◽  
Opioid Medications

Our aim was to determine the frequency and characteristics of post-surgery prescription of opioid medication and to describe patients’ handling of discharge opioid medications. We performed a multicentre prospective cohort study of adult patients undergoing elective or emergency surgery with a postoperative stay of one or more nights, with phone follow-up at two weeks after hospital discharge. The main outcome measures included the proportion of patients prescribed discharge opioid medications, post-discharge opioid use, opioid storage and disposal. Of the 1450 eligible surgical patients, opioids were dispensed on discharge to 858 (59%, 95% confidence interval (CI) (57%–62%)), with immediate-release oxycodone the most common medication. Of the 581 patients who were discharged with opioid medication and completed follow-up, 27% were still requiring opioids two weeks after discharge. Post-discharge opioid consumption was highly variable in the study cohort. The majority (70%) of patients had leftover opioids and only a small proportion (5%) reported disposal of the surplus. In a multivariate model, patients with characteristics of age 45 years or less (odds ratio, OR = 1.78, 95% CI (1.36–2.33) versus older than 45 years), American Society of Anesthesiologists’ physical status (ASA) scores of 1 or 2 (OR = 1.96, 95% CI (1.52–2.53) versus ASA score 3 to 5), higher anticipated surgical pain (OR = 1.45, 95% CI (1.08–1.94) severe versus moderate, OR = 17.48, 95% CI (5.79–52.69) severe versus nil/mild) and public funding status (OR = 1.89, 95% CI (1.36–2.64) versus other) were more likely ( P < 0.001) to receive discharge opioids. Post-surgery prescription of opioids is common and supply is often excessive. Post-discharge opioid handling included suboptimal storage and disposal.

scholarly journals Factors associated with nutritional decline in hospitalised medical and surgical patients admitted for 7 d or more: a prospective cohort study

2015 ◽  
Vol 114 (10) ◽  
pp. 1612-1622 ◽  
Author(s):  
Johane P. Allard ◽  
Heather Keller ◽  
Anastasia Teterina ◽  
Khursheed N. Jeejeebhoy ◽  
Manon Laporte ◽  
...  
Keyword(s):  
Cohort Study ◽  
Food Intake ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Medical Information ◽  
Surgical Patients ◽  
Fluid Loss ◽  
Medical Patients ◽  
Discharge Data ◽  
Factors Associated

AbstractThis prospective cohort study was conducted in eighteen Canadian hospitals with the aim of examining factors associated with nutritional decline in medical and surgical patients. Nutritional decline was defined based on subjective global assessment (SGA) performed at admission and discharge. Data were collected on demographics, medical information, food intake and patients’ satisfaction with nutrition care and meals during hospitalisation; 424 long-stay (≥7 d) patients were included; 38 % of them had surgery; 51 % were malnourished at admission (SGA B or C); 37 % had in-hospital changes in SGA; 19·6 % deteriorated (14·6 % from SGA A to B/C and 5 % from SGA B to C); 17·4 % improved (10·6 % from SGA B to A, 6·8 % from SGA C to B/A); and 63·0 % patients were stable (34·4 % were SGA A, 21·3 % SGA B, 7·3 % SGA C). One SGA C patient had weight loss ≥5 %, likely due to fluid loss and was designated as stable. A subset of 364 patients with admission SGA A and B was included in the multiple logistic regression models to determine factors associated with nutritional decline. After controlling for SGA at admission and the presence of a surgical procedure, lower admission BMI, cancer, two or more diagnostic categories, new in-hospital infection, reduced food intake, dissatisfaction with food quality and illness affecting food intake were factors significantly associated with nutritional decline in medical patients. For surgical patients, only male sex was associated with nutritional decline. Factors associated with nutritional decline are different in medical and surgical patients. Identifying these factors may assist nutritional care.

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