(Press-News.org) PITTSBURGH, Feb. 22, 2023 – New research published today in JAMA Surgery shows that when frail patients are connected to resources, including conversations with a physician about possible outcomes and help preparing their body for surgery, they are less likely to die one year after surgery.
While age can be an important indicator of a patient’s likelihood of encountering adverse outcomes or complications of surgery, it does not provide a full picture of their health. Frailty considers the patient’s overall well-being, including their physical and cognitive abilities, as well as their body’s ability to recover from surgery.
“Frailty is a particularly strong predictor of postoperative outcomes,” said Daniel Hall, M.D., corresponding author of the study and associate professor of surgery at the University of Pittsburgh School of Medicine. “Frailty can be thought of as having low physiologic reserve. Surgeries and other stressors can deplete this reserve, potentially leading to catastrophic outcomes like loss of independence or death.”
The study looked at over 50,000 patients across five UPMC hospitals who were scheduled to undergo a major surgery. Before meeting their surgeons, patients completed a brief survey to assess frailty, and a medical assistant entered the score into the electronic health record. For the 1,300 patients who met the criteria to be considered frail, the record prompted the surgeon to either have another conversation with the patient about possible frailty-associated adverse outcomes of the procedure or direct the patient to other resources, such as their primary care physician or UPMC’s Center for Perioperative Care.
After following these patients for a year, Hall and his team discovered that patients who were identified as frail and connected to any additional resources were 18% less likely to die one year after their surgery.
One explanation for this reduction in risk is that patients took advantage of these resources to make healthy lifestyle changes, such as managing their weight or quitting smoking. Another explanation is that some patients who discussed possible adverse outcomes with a physician may have chosen not to proceed with their surgery.
“As clinicians, we sometimes make the general assumption that that which can be done, should be done,” Hall said. “By discussing the possible adverse outcomes with their doctor, patients may choose a nonoperative management strategy to get their condition under control without the possible risks of surgery. This intervention allows for better goal clarification, better alignment of treatment plans with patient goals and better shared decision-making.”
Further studies are needed to determine which interventions have the biggest impact on patient outcomes, as well as how to adapt these screenings to other practice settings.
This research was supported by UPMC. Additional authors include Patrick V. Varley, M.D., University of Wisconsin School of Medicine and Public Health, Dan Buchanan, M.S., Andrew Bilderback, M.S., Mary Kay Wisniewski, M.T., Tamara Minnier, M.S.N., all of the Wolff Center at UPMC, Jason Johanning, M.D., University of Nebraska Medical Center, Joel B. Nelson, M.D., and Jonas T. Johnson, M.D., both of the University of Pittsburgh School of Medicine.
# # #
About the University of Pittsburgh School of Medicine
As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top recipients of funding from the National Institutes of Health since 1998. In rankings released by the National Science Foundation, Pitt is in the upper echelon of all American universities in total federal science and engineering research and development support.
Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see www.medschool.pitt.edu.
www.upmc.com/media
END
Patients identified as frail before surgery less likely to die one year after
2023-02-22
ELSE PRESS RELEASES FROM THIS DATE:
Association of pandemic with unsafe living situations, intimate partner violence among pregnant individuals
2023-02-22
About The Study: This study found an overall increase in unstable and/or unsafe living situations and intimate partner violence (IPV) between January 2019 and December 2020, with a temporary increase associated with the COVID-19 pandemic. It may be useful for emergency response plans to include IPV safeguards for future pandemics. These findings suggest the need for prenatal screening for unsafe and/or unstable living situations and IPV coupled with referral to appropriate support services and preventive ...
Incidence of aggressive end-of-life care among older adults with metastatic cancer in nursing homes and community settings
2023-02-22
About The Study: The results of this study suggest that despite increased emphasis to reduce aggressive end-of-life care in the past several decades, such care remains common among older persons with metastatic cancer and is slightly more prevalent among nursing home residents than their community-dwelling counterparts. Multilevel interventions to decrease aggressive end-of-life care should target the main factors associated with its prevalence, including hospital admissions in the last 30 days of life and in-hospital death.
Authors: Siran M. Koroukian, Ph.D., of the Case Western Reserve University School of Medicine in Cleveland, is the corresponding ...
Rising river temperatures hold important clues about climate and other human impacts
2023-02-22
An improved global understanding of river temperature could provide an important barometer for climate change and other human activities.
River temperature is the fundamental water quality measure that regulates physical, chemical and biological processes in flowing waters and, in turn, impacts ecosystems, human health, and industrial, domestic and recreational uses by people.
In a comment piece in the new journal, Nature Water, researchers led by the University of Birmingham, UK, and Indiana University, USA, have called for an increased ...
Human body proven to predict mealtimes
2023-02-22
The human body can predict the timing of regular meals, according to a new study from the University of Surrey. The research team also found that daily blood glucose rhythms may be driven not only by meal timing but by meal size.
In the first study of its kind, researchers from Surrey, led by Professor Jonathan Johnston, investigated if the human circadian system anticipates large meals. Circadian rhythms/systems are physiological changes, including metabolic, that follow a 24-hour cycle and are usually synchronised to environmental signals, such as light and dark cycles.
Previous ...
James Webb spots super old, massive galaxies that shouldn’t exist
2023-02-22
In a new study, an international team of astrophysicists has discovered several mysterious objects hiding in images from the James Webb Space Telescope: six potential galaxies that emerged so early in the universe’s history and are so massive they should not be possible under current cosmological theory.
Each of the candidate galaxies may have existed at the dawn of the universe roughly 500 to 700 million years after the Big Bang, or more than 13 billion years ago. They’re also gigantic, containing almost as many stars as the modern-day Milky Way Galaxy.
“It’s ...
Climate ‘spiral’ threatens land carbon stores – study
2023-02-22
The world’s forests are losing their ability to absorb carbon due to increasingly ‘unstable’ conditions caused by humans, a landmark study has found.
Dramatic changes to forests, and other habitats that store carbon in plants and soils, are becoming more likely in some regions across Earth, with less carbon consistently absorbed by the ‘land carbon sink’ provided by trees, soil and plants, according to scientists writing in Nature.
The short-term impacts of rising temperatures, ...
Anti-dust tech paves way for self-cleaning surfaces
2023-02-22
Dust is a common fact of life, and it's more than just a daily nuisance – it can get into machinery and equipment, causing loss of efficiency or breakdowns.
Researchers at The University of Texas at Austin partnered with North Carolina-based company Smart Material Solutions Inc. to develop a new method to keep dust from sticking to surfaces. The result is the ability to make many types of materials dust resistant, from spacecraft to solar panels to household windows.
The research is published in ACS Applied Materials & Interfaces.
"What we've ...
Today’s pediatric heart transplantations involve sicker children, but have better outcomes
2023-02-22
Key takeaways
Heart transplants offered to more patients with serious disease: A study of 323 pediatric heart transplants over 36 years at the University of Florida found that in recent years, more infants with serious congenital heart disease were offered heart transplants, but they had improved outcomes compared to patients in previous decades.
Improved long-term survival: Despite extending the procedure to younger patients with more serious heart problems, 5-year survival improved from 70.7% in previous years to 83% in recent ...
Deep earthquakes could reveal secrets of the Earth’s mantle
2023-02-22
A new study from a University of Chicago scientist suggests there may be a layer of surprisingly fluid rock ringing the Earth, at the very bottom of the upper mantle.
The finding was made by measuring the lingering movement registered by GPS sensors on islands in the wake of a deep earthquake in the Pacific Ocean near Fiji. Published Feb. 22 in Nature, the study demonstrates a new method to measure the fluidity of the Earth’s mantle.
“Even though the mantle makes up the largest part of Earth, there’s ...
Study offers details on using electric fields to tune thermal properties of ferroelectric materials
2023-02-22
New research from North Carolina State University sheds light on how electric fields can be used to alter the thermal properties of ferroelectric materials, allowing engineers to manipulate the flow of heat through the materials. Ferroelectric materials are used in a wide variety of applications, from ultrasound devices to memory storage technologies.
“Our work here is a significant advance because we worked with large sample sizes and provide detailed information on the relationship between the type of electric field being applied to the ferroelectric material and the thermal response in the material,” says Jun Liu, an associate professor of mechanical and aerospace ...