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<h5 class="section-title" id="d4509819e328">Importance</h5>
<p id="d4509819e330">Frailty is a measure of decreased physiological reserve that
is associated with morbidity
and mortality in major elective and emergency general surgery operations, independent
of chronological age. To date, the association of frailty with outcomes in ambulatory
general surgery has not been established.
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<h5 class="section-title" id="d4509819e333">Objective</h5>
<p id="d4509819e335">To determine the association between frailty and perioperative
morbidity in patients
undergoing ambulatory general surgery operations.
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<h5 class="section-title" id="d4509819e338">Design, Setting, and Participants</h5>
<p id="d4509819e340">A retrospective cohort study was conducted of 140 828 patients
older than 40 years
of age from the 2007-2010 American College of Surgeons National Surgical Quality Improvement
Program Participant Use File who underwent ambulatory and 23-hour-stay hernia, breast,
thyroid, or parathyroid surgery. Data analysis was performed from August 18, 2016,
to June 21, 2017.
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<h5 class="section-title" id="d4509819e343">Main Outcomes and Measures</h5>
<p id="d4509819e345">The association between the National Surgical Quality Improvement
Program modified
frailty index and perioperative morbidity was determined via multivariable logistic
regression with random-effects modeling to control for clustering within
<i>Current Procedural Terminology</i> codes.
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<h5 class="section-title" id="d4509819e351">Results</h5>
<p id="d4509819e353">A total of 140 828 patients (80 147 women and 60 681 men; mean
[SD] age, 59.3 [12.0]
years) underwent ambulatory hernia (n = 71 455), breast (n = 51 267), thyroid, or
parathyroid surgery (n = 18 106). Of these patients, 2457 (1.7%) experienced any type
of perioperative complication and 971 (0.7%) experienced serious perioperative complications.
An increasing modified frailty index was associated with a stepwise increase in the
incidence of complications. In multivariable analysis adjusting for age, sex, race/ethnicity,
anesthesia type, tobacco use, renal failure, corticosteroid use, and clustering by
<i>Current Procedural Terminology</i> codes, an intermediate modified frailty index
score (0.18-0.35, corresponding to
2-3 frailty traits) was associated with statistically significant odds ratios of 1.70
(95% CI, 1.54-1.88;
<i>P</i> < .001) for any complication and 2.00 (95% CI, 1.72-2.34;
<i>P</i> < .001) for serious complications. A high modified frailty index score
(≥0.36, corresponding
to ≥4 frailty traits) was associated with statistically significant odds ratios of
3.35 (95% CI, 2.52-4.46;
<i>P</i> < .001) for any complication and 3.95 (95% CI, 2.65-5.87;
<i>P</i> < .001) for serious complications. Anesthesia with local and monitored
anesthesia
care was the only modifiable covariate associated with decreased odds of serious 30-day
complications, with an adjusted odds ratio of 0.66 (95% CI, 0.53-0.81;
<i>P</i> < .001).
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<h5 class="section-title" id="d4509819e375">Conclusions and Relevance</h5>
<p id="d4509819e377">Frailty is associated with increased perioperative morbidity
in common ambulatory
general surgery operations, independent of age, type of anesthesia, and other comorbidities.
Surgeons should consider frailty rather than chronological age when counseling and
selecting patients for elective ambulatory surgery.
</p>
</div><p class="first" id="d4509819e380">This cohort study uses the 2007-2010 American
College of Surgeons NSQIP Participant
Use File to examine the association between frailty and perioperative morbidity in
patients undergoing ambulatory surgery.
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<h5 class="section-title" id="d4509819e386">Question</h5>
<p id="d4509819e388">Is frailty associated with perioperative morbidity in patients
undergoing ambulatory
hernia, breast, thyroid, or parathyroid surgery?
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<h5 class="section-title" id="d4509819e391">Findings</h5>
<p id="d4509819e393">In this cohort study, an increasing National Surgical Quality
Improvement Program
modified frailty index was associated with a stepwise increase in the incidence of
30-day complications; an intermediate modified frailty index (2-3 frailty traits)
and a high modified frailty index (≥4 frailty traits) were significantly associated
with any type of complication and with serious complications, respectively, in multivariable
analysis adjusting for other risk factors and clustering by operation. Anesthesia
with local and monitored anesthesia care was the only modifiable covariate associated
with decreased odds of serious 30-day complications.
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<h5 class="section-title" id="d4509819e396">Meaning</h5>
<p id="d4509819e398">Frailty is independently associated with perioperative morbidity
in patients undergoing
common ambulatory general surgery and should be considered in patient selection and
counseling.
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