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Invited Commentary
June 2016

Frailty and Mortality After Noncardiac Surgery in Elderly IndividualsMetrics, Systems, and the Elephant

Author Affiliations
  • 1Department of Surgery, Nebraska Western Iowa VA Medical Center, Omaha
  • 2Department of Surgery, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
  • 3Division of Vascular Surgery and Endovascular Therapy, Surgery Research, Emory University, Atlanta, Georgia
JAMA Surg. 2016;151(6):545-546. doi:10.1001/jamasurg.2015.5235

Frailty is increasingly recognized as a key determinant of poor surgical outcomes. The impact of frailty assessment at the patient and system level has significant implications.

With this rigorous population-based, retrospective cohort study of surgical patients in Ontario, Canada, McIsaac and colleagues1 add to the growing literature demonstrating markedly increased risks frailty imposes on surgical populations. Using sophisticated and measured statistical analyses, the Johns Hopkins Adjusted Clinical Groups frailty score was used to model risk of death from day of surgery to 1 year, in contrast to many databases limited to 30-day outcomes. This extended timeframe demonstrates in Canada the frailty-associated mortality risk after surgery is greatest in the first 3 days (hazard ratio = 35.6) declining rapidly over 10 days and stabilizing by 90 days. In a similar, but contrasting, study, surgical patients in the Veterans Affairs highest-risk group (bottom decile) demonstrated a stable mortality rate over time during the first 30 days that continued over 1 year.2

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