NDLI: Measurement and validation of frailty as a predictor of outcomes in women undergoing major gynaecological surgery.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	George, E. M. Burke, W. M. Hou, J. Y. Tergas, A. I. Chen, L. Neugut, A. I. Ananth, C. V. Hershman, D. L. Wright, J. D.
Description	Country affiliation: United States Author Affiliation: George EM ( Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.); Burke WM ( Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.); Hou JY ( Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.); Tergas AI ( New York Presbyterian Hospital, New York, NY, USA.); Chen L ( Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.); Neugut AI ( Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.); Ananth CV ( New York Presbyterian Hospital, New York, NY, USA.); Hershman DL ( Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.); Wright JD ( Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.)
Abstract	OBJECTIVE: Frailty is the loss of physical or mental reserve that impairs function, often in the absence of a defined comorbidity. Our aim was to determine whether a modified frailty index (mFI) correlates with morbidity and mortality in patients undergoing hysterectomy. DESIGN: Retrospective cohort study. SETTING: Hospitals across the USA participating in the National Surgical Quality Improvement Program (NSQIP). SAMPLE: Patients who underwent hysterectomy from 2008 to 2012. METHODS: An mFI was calculated using 11 variables in NSQIP. The associations between mFI and morbidity and mortality were assessed. Model fit statistics (c-statistics) were utilised to evaluate the ability of mFI to distinguish outcomes. MAIN OUTCOME MEASURE: Wound infection, severe complications and mortality. RESULTS: A total of 66 105 patients were identified. Wound complications increased from 2.4% in patients with an mFI of zero to 4.8% in those with mFI ≥ 0.5 (P < 0.0001). Similarly, severe complications increased from 0.98% to 7.3% (P < 0.0001), overall complications rose from 3.7% to 14.5% (P < 0.0001) and mortality increased from 0.06% to 3.2% (P < 0.0001) for patients with a frailty index of zero compared with those with an index of ≥ 0.5. Versus chance, the goodness-of-fit c-statistics suggested that mFI increases the ability to detect wound complications by 11.4%, severe complications by 22.0% and overall complications by 11.0%. CONCLUSIONS: The mFI is easily reproducible from routinely collected clinical data and predictive of outcomes in patients undergoing hysterectomy. Frailty may be useful in the preoperative risk assessment of women undergoing gynaecological surgery. TWEETABLE ABSTRACT: Frailty may be useful in the preoperative risk assessment of women undergoing gynaecological surgery.
File Format	HTM / HTML
ISSN	14700328
e-ISSN	14710528
Journal	BJOG: An International Journal of Obstetrics & Gynaecology
Issue Number	3
Volume Number	123
Language	English
Publisher	Wiley
Publisher Date	2016-02-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Obstetrics Discipline Gynecology Hysterectomy Postoperative Complications Epidemiology Cohort Studies Frail Elderly Prognosis Retrospective Studies Risk Assessment Research Support, N.i.h., Extramural Validation Studies
Content Type	Text
Resource Type	Article
Subject	Obstetrics and Gynecology

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