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    Research Letter
    July 13, 2020

    Association of Preoperative Frailty and Operative Stress With Mortality After Elective vs Emergency Surgery

    Author Affiliations
    • 1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
    • 2Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
    • 3Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
    • 4Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
    • 5Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
    • 6Department of Surgery, University of Texas Health San Antonio, San Antonio
    • 7South Texas Veterans Health Care System, San Antonio
    • 8Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California
    • 9Surgical Service Line, VA Palo Alto Healthcare System, Palo Alto, California
    • 10Division of Health Services Research and Development, VA Palo Alto Healthcare System, Palo Alto, California
    • 11Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
    • 12Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    JAMA Netw Open. 2020;3(7):e2010358. doi:10.1001/jamanetworkopen.2020.10358

    Our group recently examined the associations among preoperative frailty, operative stress, and postoperative mortality in a retrospective cohort published in JAMA Surgery.1 Frail and very frail patients had high mortality rates at 30, 90, and 180 days even after low-stress operations, a finding that triggered questions about whether inclusion of patients undergoing emergency operations may have been associated with the high mortality rate. We hypothesized that postoperative mortality would increase with increasing frailty and increasing operative stress for both elective and emergent operations, with high levels of mortality for frail and very frail patients even after low-stress, elective operations.