Frailty Level Accurate Predictor of Post-op Complications

Assessing a patient’s level of frailty before an operation can provide important insight into which individuals might develop postoperative complications.

A study by Dr. Balzer and his colleagues conducted a review of patients 65 years of age or older who were seen in the outpatient anesthesiology department for elective surgery from Jan. 14, 2016 through April 30, 2016. A frailty assessment was administered to 196 patients, consisting of a grip strength measurement, timed up-and-go test, a hemoglobin test, and a body mass index or serum albumin level as a test for malnutrition.

The patients were assigned 1 point for each pathologic test result. Patients scoring 0 to 1 point were designated “non-frail” (reference group; 68%); those with 2 points were “pre-frail” (23%) and those with 3 to 4 points were “frail” (9%). Postoperative complications were analyzed via ICD-10 diagnosis codes, and European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA) guidelines were used to estimate operative risk.

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Preoperative risk stratification of critically ill patients

Copeland, C.C. et al. (2017) The Journal of Clinical Anesthesia. 39 (June) pp. 122–127

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Highlights:

  • Preoperative assessment of critically ill patients is challenging and understudied.
  • ASA class, RCRI, and SOFA score were studied to predict survival to discharge.
  • One in four ICU patients did not survive to discharge after an intervention.
  • Available scores inadequately discriminated between survivors and non-survivors.
  • SOFA score (AUC = 0.68) outperformed ASA class (AUC = 0.59).

Read the full abstract here

Childhood & adolescent risk and prognostic factors for musculoskeletal pain

Huguet, A. et al. (2016) Pain. 157(12) pp. 2640–2656

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Image source: Tim Ellis – Wellcome Images // CC BY-NC-ND 4.0

A variety of factors may be involved in the development and course of musculoskeletal (MSK) pain.

We undertook a systematic review with meta-analysis to synthesize and evaluate the quality of evidence about childhood and adolescent factors associated with onset and persistence of MSK pain, and its related disability.

No study was identified that examined prognostic factors for MSK pain–related disability. High-quality evidence suggests that low socioeconomic status is a risk factor for onset of MSK pain in studies exploring long-term follow-up. Moderate-quality evidence suggests that negative emotional symptoms and regularly smoking in childhood or adolescence may be associated with later MSK pain. However, moderate-quality evidence also suggests that high body mass index, taller height, and having joint hypermobility are not risk factors for onset of MSK pain. We found other risk and prognostic factors explored were associated with low or very low quality of evidence.

Additional well-conducted primary studies are needed to increase confidence in the available evidence, and to explore new childhood risk and prognostic factors for MSK pain.

Read the full abstract here

Health risk factors in the anesthesia population

  • The prevalence of lifestyle risk factors in perioperative patients is high.
  • A total of 30.1% of patients had no lifestyle risk factor.
  • The most prevalent health risk factors were overweight, smoking, and hypertension.
  • Overweight and hypertension are frequently underreported by patients.
  • Patient self-reports require critical appraisal.

Study objective

We investigated the prevalence of lifestyle risk factors in patients admitted to our preoperative assessment outpatient clinic, and compared patient self-reports and anesthetist reports of health risk factors to evaluate the patient self-image of preoperative health status.

Design

Cross-sectional survey.

Setting

The study was performed in an academic teaching hospital in Amsterdam, the Netherlands, during 3 consecutive months at the preoperative screening clinic.

Patients

A total of 1227 adult patients scheduled for surgery were screened, and 1111 were included (patients being excluded where data were incomplete).

Interventions and measurements

Before health risk screening by an anesthetist, patients filled out a lifestyle risk factor questionnaire including overweight, hypertension, diabetes mellitus, smoking, physical activity, and alcohol use. These were compared with risk factors stated in the preoperative assessment report of the anesthetist.

Main results

The study population was aged 51 ± 17 years with a body mass index of 25.6 ± 4.7 kg/m2. The most frequent lifestyle risk factors reported by the anesthetist were overweight and obesity (47.5%), smoking (25.3%), and hypertension (23.7%). The prevalence of no, 1, or 2 lifestyle risk factors in the preoperative assessment outpatient clinic population was, respectively, 30.1%, 35.6%, and 18.5% reported by the anesthetist and 36.4%, 36.7%, and 18.6% reported by the patients. Patients with more lifestyle risk factors were older with a higher body mass index and American Society of Anesthesiologists classification. Differences in reporting of lifestyle risk factors between patients and anesthetist occurred especially with overweight (26.5% vs 47.5%).

Conclusions

The prevalence of lifestyle risk factors in perioperative patients is high, and differences in reporting between patients and anesthetists may suggest that patients are unaware of or ignore their unhealthy state. Further studies are warranted to investigate the association between the lifestyle risk factors and outcome in the anesthesiology setting.

Full reference: Scharwächter, W.H. et al. Health risk factors in the anesthesia population Journal of Clinical Anesthesia. Volume 32, Pages 33–39