Defense Date

2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Health Related Sciences

First Advisor

T. Corey Davis PhD, CRNA

Second Advisor

Clarence Biddle PhD, CRNA

Third Advisor

Patricia Slattum Pharm D, PhD

Fourth Advisor

Armin Shahrokni MD

Fifth Advisor

Beverly George-Gay DNP

Abstract

Frailty is roughly defined as an accumulation of physiological, emotional, cognitive, and social deficits that impair a person’s response to stressful events. A frailty diagnosis has been associated with poor outcomes following surgical procedures. Cancer surgical patients aged 65 or older represent a vulnerable population susceptible to being frail and the potential associated complications that can accompany frailty. Measuring frailty is an objective risk assessment that identifies increased risk better than age or American Society of Anesthesiologists Physical Status (ASA-PS) score such that frailty can independently predict poor surgical outcomes.

Frailty is not specifically a result of having cancer, disability, or advanced age. It represents a separate syndrome that diminishes a person’s response to stressful event. The assumption is there are certain domains that encompass a generally accepted definition of frailty that remains applicable to most frailty measures. These domains include comorbidities as well as functional, physiological, nutritional, and psychological statuses. Social activity and social support represent other important areas that the most comprehensive frailty indexes consider in their scoring. Frailty can be assessed using at frailty index where higher scores correlate with greater susceptibility to poor outcomes. The Memorial Sloan Kettering Frailty Index (MSK-FI) was the frailty measurement used for this dissertation.

Using Rockwood’s Frailty Theory of Accumulated Deficits, a non-randomized, non-experimental, retrospective cohort study was conducted.

The independent variable was frailty score. The dependent variables were Intensive Care Unit admission (ICU), Specialized Advanced Care Unit admission (SACU), and 30-day readmission. The sample population consisted of surgical patients, aged 65 or older, who had a surgical procedure at Memorial Sloan Kettering Cancer Center from January 1, 2015 to December 31, 2018.

There were 4,417 subjects in this retrospective analysis. Multivariate logistic regression with fixed effect models were created to assess the relation between frailty and postsurgical admission to the ICU, SACU, and 30-day readmission. The researcher found evidence of an association between greater frailty and increased risk of admission to the ICU (OR 1.44; 95% CI 1.31, 1.59; p-value <0.001), admission to the SACU (OR 1.46; 95% CI 1.33, 1.60; p-value <0.001), and 30-day readmission (OR 1.09, 95% CI 1.02, 1.177; p-value = 0.012).

This study demonstrated that a significant correlation between frailty status and postsurgical ICU admission, SACU admission, and 30-day readmission in geriatric cancer surgical patients exists. Using a frailty assessment in the preoperative assessment has the potential to identify high-risk geriatric patients who may have an elevated risk for poor outcomes following their surgical procedure. Once high-risk patients are identified, a multidisciplinary team can create a patient centered treatment plan and mobilization of appropriate resources to minimize poor outcomes.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

1-27-2021

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