Researchers from the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh conducted a study involving 9,153 elderly patients undergoing major elective surgery at a Veterans Affairs hospital. All patients were screened for frailty using the Risk Analysis Index, a 14-item questionnaire. When patients’ RAI score determined them to be frail, their records were flagged for administrative review by the chief of surgery prior to the operation. Then, clinicians from surgery, anesthesia, crucial care and palliative care were notified of any risks.
Before the screening initiative, the hospital’s mortality rate was 1.6 percent (84 of 5,275 patients). After implementation of frailty screening, mortality rate decreased to 0.7 percent (26 of 3,878 patients).
Improvement was greatest among frail patients, reducing mortality from 12.2 percent to 3.8 percent.
The authors believe multiple factors contributed to the mortality rate decrease, such as changes in preoperative decision-making, management during surgery and postoperative rescue.
“This study reveals the feasibility of facility-wide frailty screening in elective surgical populations,” the authors concluded. “It also suggests the potential to improve postoperative survival among the frail through systematic administrative screening, review and optimization of perioperative plans.”
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