SLR - October 2017 - Jesse R. Wolfe

Association of the Modified Frailty Index with 30-Day Surgical Readmission

Reference: Wahl TS, Graham LA, Hawn MT, Richman J, Hollis RH, Jones CE, Copeland LA, Burns EA, Italni KM, Morris MS. Association of the Modified Frailty Index with 30-Day Surgical Readmission. JAMA Surg. 2017 Aug 1;152(8):749–757.

Scientific Literature Review

Reviewed By: Jesse R. Wolfe, DPM
Residency Program: SSM Health DePaul Hospital, St. Louis, MO

Podiatric Relevance: Podiatric surgeons have become increasingly involved in the medical and surgical care of hospitalized geriatric patients who present with multiple and complex comorbidities. The multiple frailty index (mFI) was designed to assess patients at risk for hospital readmission within 30 days following surgical procedures and may prove helpful to podiatric surgeons in identifying at-risk patients for recurrent hospitalizations.

Methods: A retrospective chart review was performed by the Veterans Health Administration across 118 hospitals between 2007 and 2014. The mFI is expressed as an index ratio based on the following frailty comorbidity variables: Nonindependence, controlled diabetes, history of chronic obstructive pulmonary disease (COPD) or pneumonia within the previous 30 days, congestive heart failure (CHF) exacerbation within previous 30 days, myocardial infarction (MI) within previous six months, history of angina within previous 30 days or any percutaneous coronary intervention or bypass grafting, hypertension (HTN) requiring medication, history of peripheral vascular disease (PVD), acutely impaired sensorium, transient ischemic attack (TSA) or cerebrovascular accident (CVA) without deficits and CVA with deficits. The mFI is defined through assigning one point to each comorbidity present divided by the total 11 possible comorbidities.

Results: The mFI study analyzed 236,957 procedures across orthopaedic, general and vascular surgical specialties. Patients who presented with 0 mFI variables had a hospital readmission average of 7.9 percent (n=47,251[mFI=0]), 1 mFI variable averaged 8.9 percent readmission (n=76,721[mFI=0.09]), two mFI variables averaged 11.2 percent readmission (n=61205[mFI=0.18]). The presence of three or more variables (mFI=0.27) were associated with prolonged postoperative hospitalization, significant increased risk for readmission, postoperative complication and posthospitalization mortality. The most strongly correlated readmission mFI variables risk factors were nonindependence functional status and CVA with residual deficits.

Conclusion: Preoperative frailty has been shown to correlate with increased risk for postoperative complications, prolonged hospital admission with discharge to a healthcare facility and mortality. Often, podiatric surgeons are involved in the care of patients with >3 mFI variables (diabetes, peripheral vascular disease, decreased functional status). The mFI can be a helpful tool to aid the podiatric physician in identifying frail patients who are likely to suffer from an adverse posthospitalization event.

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