Debility Risk Model as a Predictor for Postsurgical Outcomes. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Hanna, Yousif; Nandra, Kulvir; Kustera, Christopher; Smith, Jessica; Metzinger, Matthew; Patel, Kamini; Cowan, Scott
• Is Part Of: American surgeon. Volume 87:Issue 9(2021)
• Page Start: 1457
• Page End: 1462
• Publication Date: 2021-09
• Subjects: debility -- frailty -- patient outcomes -- surgical outcomes -- readmissions -- postoperative complications; Surgery -- Periodicals; Surgery -- United States -- Periodicals; 617.0973
• DOI: 10.1177/0003134820956294
• Languages: English
• ISSNs: 0003-1348

Abstract

Background: Decreased patient functional status is associated with higher rates of postoperative morbidity and mortality. The Vizient program recently implemented a debility risk model to identify patients with impaired functional status. We examined the relationship between this novel model and inpatient postsurgical outcomes in a large urban tertiary care center. Methods: The Vizient database was accessed to compare surgical outcomes between patients coded with debility and patients without debility between January 2017 and December 2018. Data for each surgical specialty were obtained, and a chi-squared analysis was used to detect differences in readmission rates, mortality, and postoperative complications (defined by Vizient). These complications include pneumonia, postoperative infection, anesthesia complications, and shock. Results: We found patients with debility have a higher mortality rate (3%) than patients without debility (2%) across all surgical specialties ( P = .0103). Patients with debility have a higher 30-day readmission rate (16%) than those without debility (8%) across all specialties ( P < .0001). Patients with debility had a higher rate of inpatient complications for neurosurgery (12.11% vs. 8%, P = .008), trauma surgery (11.9% vs. 6%, P =.025), general surgery (17.67% vs. 7%, P = .013), and cardiac surgery (47.06% vs. 18%, P =.0025). Conclusions: Our study supports the use of the Vizient debility code to predict postsurgical outcomes and risk stratify patients. By extension, functional status assessments in preoperative evaluation of patients remain important. Further, studies can build upon this data to measure the impact of preoperative, outpatient debility assessments in surgical patients.