(Press-News.org) SAN FRANCISCO: A simplified frailty index created by surgeons at Wayne State University School of Medicine in Detroit, Mich., is a reliable tool for assessing risk of mortality and serious complications in older patients considering total hip and knee replacement procedures, according to new study findings presented today at the 2014 Clinical Congress of the American College of Surgeons.
As more seniors stay healthier longer, elective operations such as hip and knee replace-ments are becoming more common. Traditionally, a person's eligibility for surgery has been based largely upon biological age. In recent years, however, a person's level of frailty (under-stood as a general decline in functional status) has come to be recognized as an independent risk factor for adverse health outcomes.
"We felt that age and general impression of the patient wasn't adequate for predicting outcomes, so we created a simplified frailty index to stratify risk of mortality and morbidity in surgical patients," said study coauthor Peter Adams, MD, a resident in general surgery at Henry Ford Hospital, Detroit, Mich. "We started our analysis in elderly emergent patients, and then moved on to vascular patients, and with this research, we have narrowed it down to two specific procedures."
While a number of different indices exist for measuring age-related frailty, the index used in this study is the only one directly mapped to the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) database.
"The advantage is that NSQIP provides a very large sample size and better quality data than our typical retrospective chart reviews," Dr. Adams said. "And the fact that we can get a large sample size for specific types of surgeries allows us to narrow down our data and be more precise in our understanding of individual patient populations and procedures in terms of risk."
The simplified frailty index takes into account 11 data points collected by the ACS NSQIP database. Since most of these variables are considered co-morbidities, such as history of heart attack, stent and hypertension, health care providers can easily calculate a patient's frailty score by taking a simple medical history. No laboratory values are included.
For the study, Dr. Adams and his colleagues used the ACS NSQIP database to identify total joint replacements between 2006 and 2012. Overall, frailty scores were calculated for 40,469 patients. Frailty scores ranged from 0 (no positive frailty values) to 0.64 (four positive frailty values) with a mean score of .10. Mean age was 66, and 61 percent of the patients underwent total knee replacement surgery and 39 percent had hip replacement surgery.
Since the majority of patients in this study had four or less positive frailty values, the maximum assigned score was 4/11, rather than 11/11.
Using the index, study authors found a significant mortality rate for the 462 patients with high frailty scores. Patients with no frailty associated values (a frailty score of 0) had a mortality rate of 0.08 percent, but those with four values (a frailty score of 0.36), had a mortality rate of 2 percent.
The research also found that risk of serious postoperative complications increased from .67 percent (with no frailty associated values) to 6.24 percent (with four frailty values). Furthermore, this frailty test was shown to be a more reliable predictor of death and serious complications than patient age.
"I think using our frailty index can kind of enlighten surgeons into recognizing that even if they are doing an elective case, such as total knee or hip replacement, sicker patients who have significant medical histories may have a high risk of wound infections and even mortality," Dr. Adams said. "This frailty score will allow surgeons to have accurate and meaningful conversations with patients about their risk."
Importantly, Dr. Adams points out that this frailty score could also be used to show that elderly patients should not be denied an option for surgical treatment. Patients who have low frailty scores will probably do well and should be considered on the merits of their health, and not solely on age.
INFORMATION:
Other study participants include Rob M. Weir, MD, Heath Antoine, MD, Ryan Kather, and Ilan S. Rubinfeld, MD, FACS. All are from the Henry Ford Health System in
Detroit
SAN FRANCISCO: Delayed treatment for appendicitis can often lead to a ruptured appendix. That's exactly what is more likely to happen to many children in North Carolina if they have to delay getting treatment because of poor access to general surgeons, according to new study findings presented this week at the American College of Surgeons 2014 Clinical Congress.
Appendicitis is a common condition, but previous research has shown that complications from the condition may be directly tied to living in an area without enough general surgeons. Findings from a May 2014 ...
PROVIDENCE, R.I. [Brown University] — Enterovirus. Tuberculosis. Cholera. Measles. Various strains of the flu and hepatitis. The number of infectious disease outbreaks and the number of unique illnesses causing them appear to be increasing around the globe, according to a new Brown University analysis of more than 12,000 outbreaks affecting 44 million people worldwide over the last 33 years.
Menacing as that may sound, these preliminary findings also reveal an encouraging trend. On a per capita basis, the impact of the outbreaks is declining. In other words, even ...
Scientists have long sought to identify the specific DNA changes that can trigger new traits, allowing species to adapt. But when animals develop a new trait, are the mutations within the part of the DNA that makes proteins, or, in the master switches that control the gene, modulating its activity to turn on or off?
For development of the embryo, it is usually the master control regions of a gene that dominate, but what about in an adult?
Jasper et al. found that adults play by a different set of rules, relying on the contributions of novel genes---called taxonomically ...
And you thought the sexual battles between people could get weird and fierce? Try ants. In a new study, biologists at the University of Vermont have discovered some queen ants that make sexual bondage into a life and death fight.
In a discovery new to science, their research shows that sexual conflict between two species can drive an evolutionary bedroom-battle royal, leading to competing adaptations in which female ants of one species manage to manhandle sperm away from the unwitting males of a different species during intercourse. The study was published in the October ...
A high milk intake in women and men is not accompanied by a lower risk of fracture and instead may be associated with a higher rate of death, suggests observational research published in The BMJ this week.
This may be explained by the high levels of lactose and galactose (types of sugar) in milk, that have been shown to increase oxidative stress and chronic inflammation in animal studies, say the researchers.
However, they point out that their study can only show an association and cannot prove cause and effect. They say the results "should be interpreted ...
Richard Wakeford, Life Fellow at Hughes Hall in the University of Cambridge, warns that the NHS needs more GPs immediately – and that without a complete reorganisation of student recruitment, medical schools "will continue to overproduce graduates inclined to hospital specialties and research."
Workforce reports show that we need at least half of UK medical graduates to become GPs, yet UK medical schools "are not recruiting students with this career inclination in anything like sufficient numbers," he writes.
He points out that Labour has announced plans for 8,000 ...
The systematic neglect of culture is the single biggest barrier to advancing the highest attainable standard of health worldwide, say the authors of a major new report on culture and health, led by Professor David Napier, a leading medical anthropologist from University College London (UCL), UK, and published in The Lancet.
Bringing together experts from many different fields, including anthropologists, social scientists, and medics, the Commission is the first ever detailed appraisal of the role of culture in health. The authors argue that cultures of all kinds – ...
Glioma is a common name for serious brain tumours. Different types of glioma are usually diagnosed as separate diseases and have been considered to arise from different cell types in the brain. Now researchers at Uppsala University, together with American colleagues, have shown that one and the same cell of origin can give rise to different types of glioma. This is important for the basic understanding of how these tumours are formed and can contribute to the development of more efficient and specific glioma therapies. The results have been published in Journal of Neuroscience.
The ...
AMHERST, Mass. – Binge drinking can have lasting effects on brain pathways that are still developing during adolescence, say neuroscience researcher Heather N. Richardson and her colleagues at the University of Massachusetts Amherst and Louisiana State University. Results of their study using a rodent model of adolescent drinking appear in the October 29 issue of The Journal of Neuroscience.
Richardson says, "Adverse effects of this physical damage can persist long after adolescent drinking ends. We found that the effects of alcohol are enduring." She adds, "The ...
WASHINGTON, DC — Heavy drinking during adolescence may lead to structural changes in the brain and memory deficits that persist into adulthood, according to an animal study published October 29 in The Journal of Neuroscience. The study found that, even as adults, rats given daily access to alcohol during adolescence had reduced levels of myelin — the fatty coating on nerve fibers that accelerates the transmission of electrical signals between neurons. These changes were observed in a brain region important in reasoning and decision-making. Animals that were ...
