Frailty as a prognostic factor for the critically ill older adult trauma patients

Mohammad Hamidi; Muhammad Zeeshan; Valeria Leon-Risemberg; Janko Nikolich-Zugich; Kamil Hanna; Narong Kulvatunyou; Abdul Tawab Saljuqi; Mindy Fain; Bellal Joseph

doi:10.1016/j.amjsurg.2019.01.035

Frailty as a prognostic factor for the critically ill older adult trauma patients

Am J Surg. 2019 Sep;218(3):484-489. doi: 10.1016/j.amjsurg.2019.01.035. Epub 2019 Feb 22.

Authors

Mohammad Hamidi¹, Muhammad Zeeshan², Valeria Leon-Risemberg³, Janko Nikolich-Zugich⁴, Kamil Hanna⁵, Narong Kulvatunyou⁶, Abdul Tawab Saljuqi⁷, Mindy Fain⁸, Bellal Joseph⁹

Affiliations

¹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: [email protected].
² Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: [email protected].
³ The University of Arizona College of Medicine, Tucson, United States. Electronic address: [email protected].
⁴ Department of Immunobiology College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: [email protected].
⁵ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: [email protected].
⁶ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: [email protected].
⁷ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: [email protected].
⁸ Section of Geriatrics, General Internal Medicine and Palliative Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: [email protected].
⁹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: [email protected].

PMID: 30833015
DOI: 10.1016/j.amjsurg.2019.01.035

Abstract

Background: Frailty is highly prevalent in the elderly and confers high risk for adverse outcomes. We aimed to assess the impact of frailty on critically ill older adult trauma patients.

Methods: We analyzed the ACS-TQIP(2010-2014) including all critically-ill trauma patients ≥65y. The modified frailty index (mFI) was calculated. Following stratified into frail and non-frail, propensity score matching was performed. Our primary outcome measure was in-hospital complications. Secondary outcome measures included mortality and discharge disposition.

Results: We identified 88,629 patients, of which 34,854 patients (frail: 17,427, non-frail: 17,427) were matched. Overall 14% died. Frail patients had higher rates of complications (34% vs. 18%, p < 0.001), mortality (18.1% vs. 9.7%, p < 0.001), and were more likely to be discharged to rehab/SNF (58.7% vs. 21.2% p < 0.001) compared to non-frail patients.

Conclusion: critically-ill frail patients are more likely to have higher morbidity and mortality. Frailty can be used as an objective measure to identify high-risk patients.

Keywords: Complications; ICU; In-hospital; Mortality; Trauma.

MeSH terms

Aged
Aged, 80 and over
Critical Illness
Female
Frailty / complications*
Humans
Male
Prognosis
Retrospective Studies
Risk Factors
Wounds and Injuries / complications*
Wounds and Injuries / mortality*