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Comment & Response
May 12, 2021

Frailty Assessment and Shared Decision-making—Reply

Author Affiliations
  • 1Division of Trauma, Burn, and Surgical Critical Care, Surgery Department, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Surg. 2021;156(9):890. doi:10.1001/jamasurg.2021.1473

In Reply We thank Kraiss and Brooke for their interest in our article titled “Association of Frailty With Morbidity and Mortality in Emergency General Surgery by Procedural Risk Level.”1 They bring up important critiques, and we are pleased to further the discussion on frailty assessment and its association with emergency general surgery outcomes.

Their first comment centers on our use of frailty as a binary variable and in the possibility of a dose-response effect of frailty in mortality of this cohort. In the initial stages of our study, we classified elderly patients into 4 categories: not frail, prefrail, frail, and very frail. We found that when frailty increased, mortality also increased (2.65%, 5.58%, 9.43%, and 11.59% in each frailty category, respectively). However, because our analysis required further stratification to determine the association of procedural risk level in the association of frailty and mortality, we decided to dichotomize frailty similar to previous studies.2

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