Impact of frailty, malnutrition and socioeconomic status on perioperative outcomes.

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dc.contributor.authorStretton, B.
dc.contributor.authorBooth, A.E.C.
dc.contributor.authorKovoor, J.
dc.contributor.authorGupta, A.
dc.contributor.authorEdwards, S.
dc.contributor.authorHugh, T.
dc.contributor.authorMaddison, J.
dc.contributor.authorTalley, N.J.
dc.contributor.authorPlummer, M.
dc.contributor.authorMeyer, E.
dc.contributor.authorHorowitz, M.
dc.contributor.authorBarreto, S.
dc.contributor.authorPadbury, R.
dc.contributor.authorBacchi, S.
dc.contributor.authorMaddern, G.
dc.contributor.authorBoyd, M.
dc.date.issued2024
dc.description.abstractBackground: Frailty, malnutrition and low socioeconomic status may mutually perpetuate each other in a self-reinforcing and interdependent manner. The intertwined nature of these factors may be overlooked when investigating impacts on perioperative outcomes. This study aimed to investigate the impact of frailty, malnutrition and socioeconomic status on perioperative outcomes. Methods: A multicentre cohort study involving six Australian tertiary hospitals was undertaken. All consecutive surgical patients who underwent an operation were included. Frailty was defined by the Hospital Frailty Risk Score, malnutrition by the Malnutrition Universal Screening Tool (MUST) and low socioeconomic status by the Index of Relative Socioeconomic Disadvantage. Linear mixed-effects and binary logistic generalised estimated equation models were performed for the outcomes: inpatient mortality, length of stay, 30-day readmission and re-operation. Results: A total of 21 976 patients were included. After controlling for confounders, malnutrition and socioeconomic status, patients at high risk of frailty have a mean hospital length of stay 3.46 times longer (mean ratio = 3.46; 95% confidence interval (CI): 3.20, 3.73; P value < .001), odds of 30-day readmission 2.4 times higher (odds ratio = 2.40; 95% CI: 2.19, 2.63; P value < .001) and odds of in-hospital mortality 12.89 times greater than patients with low risk of frailty (odds ratio = 12.89; 95% CI: 4.51, 36.69; P value < .001). Elevated MUST scores were also significantly associated with worse outcomes, but to a lesser extent. Socioeconomic status had no association with outcomes. Conclusion: Perioperative risk evaluation should consider both frailty and malnutrition as separate, significant risk factors. Despite strong causal links with frailty and malnutrition, socioeconomic disadvantage is not associated with worse postoperative outcomes. Additional studies regarding the prospective identification of these patients with implementation of strategies to mitigate frailty and malnutrition and assessment of perioperative risk are required.
dc.description.statementofresponsibilityBrandon Stretton, Andrew E.C.Booth, Joshua Kovoor, Aashray Gupta, Suzanne Edwards, Tom Hugh, John Maddison, Nicholas J. Talley, Mark Plummer, Emily Meyer, Michael Horowitz, Savio Barreto, Robert Padbury, Stephen Bacchi, Guy Maddern, Mark Boyd
dc.identifier.citationAge and Ageing, 2024; 53(12):afae263-1-afae263-10
dc.identifier.doi10.1093/ageing/afae263
dc.identifier.issn0002-0729
dc.identifier.issn1468-2834
dc.identifier.orcidStretton, B. [0000-0002-7939-3489]
dc.identifier.orcidBooth, A.E.C. [0009-0005-0023-6552]
dc.identifier.orcidKovoor, J. [0000-0002-3880-3840]
dc.identifier.orcidGupta, A. [0000-0002-8038-0378]
dc.identifier.orcidEdwards, S. [0000-0003-2074-1685]
dc.identifier.orcidMaddison, J. [0000-0001-8692-8878]
dc.identifier.orcidPlummer, M. [0000-0002-9640-1911]
dc.identifier.orcidMeyer, E. [0000-0002-7450-5808]
dc.identifier.orcidHorowitz, M. [0000-0002-0942-0306]
dc.identifier.orcidBacchi, S. [0000-0001-5130-8628]
dc.identifier.orcidMaddern, G. [0000-0003-2064-181X]
dc.identifier.orcidBoyd, M. [0000-0002-6848-3307]
dc.identifier.urihttps://hdl.handle.net/2440/146624
dc.language.isoen
dc.publisherOxford University Press
dc.rights© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com
dc.source.urihttps://doi.org/10.1093/ageing/afae263
dc.subjectfrailty; malnutrition; outcomes; perioperative medicine; socioeconomic status; older people
dc.subject.meshHumans
dc.subject.meshMalnutrition
dc.subject.meshTreatment Outcome
dc.subject.meshLength of Stay
dc.subject.meshPatient Readmission
dc.subject.meshSurgical Procedures, Operative
dc.subject.meshReoperation
dc.subject.meshGeriatric Assessment
dc.subject.meshHospital Mortality
dc.subject.meshLinear Models
dc.subject.meshLogistic Models
dc.subject.meshOdds Ratio
dc.subject.meshRisk Assessment
dc.subject.meshRisk Factors
dc.subject.meshAge Factors
dc.subject.meshNutritional Status
dc.subject.meshTime Factors
dc.subject.meshSocial Class
dc.subject.meshAged
dc.subject.meshAged, 80 and over
dc.subject.meshFrail Elderly
dc.subject.meshMiddle Aged
dc.subject.meshAustralia
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshTertiary Care Centers
dc.subject.meshSocial Determinants of Health
dc.subject.meshFrailty
dc.titleImpact of frailty, malnutrition and socioeconomic status on perioperative outcomes.
dc.typeJournal article
pubs.publication-statusPublished

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