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Objective: The association between frailty and mortality is well documented, we hypothesized this is secondary to failure to rescue (F2R).
Design: Cohort
Setting: Hospitals enrolled in ACS NSQIP®
Patients: Surgical patients
Interventions: Thoracoabdominal surgery
Main Outcome Measures: Frailty, complications, and mortality
Methods: The modified frailty index (MFI) was use to classify patients as not- (0 points), mildly (1 point), moderately (2 points), and severely (=/>3) frail.
Results 962,913 were included, majority were non-frail (52.2%) followed by mildly frail (33.8%). Complications were noted in 15.3%, major complications in 9.5%, mortality in 1.8% and F2R in 1.3% of patients. On multivariate analysis increases in frailty were associated with increases in the risk of major complications (mildly RR 1.51, moderately RR 2.69, and severely frail RR 5.63 compared to the non-frail, p<0.0001), and death (mildly frail RR 1.84, moderately frail RR 4.44, severely frail RR 12.4). On univariate analysis, older, males, those undergoing small bowel interventions, gastric surgery or other procedures, and the frail were more likely experience F2R, (p<0.0001). On multivariate analysis males (RR1.07), those undergoing small bowel intervention (RR 1.91), gastric surgery (RR 1.83) and other procedures (RR 2.43) compared to hernia repair were more likely to experience F2R. As the frailty index increased F2R increased (mildly frail RR 1.48, moderately frail RR 2.41, and severely frail RR 4.41), p<0.0001. Components of the MFI were analyzed separately, measures of impaired functional status were independently associated with increased F2R (RR2.91, p<0.0001), whereas, those measuring co-morbid medical conditions were not.
Conclusion: Increases in frailty independently predicts risk for F2R. The greatest predictors of F2R in the MFI are those associated with disability and not medical co-morbidities.