Frailty Is Associated with Increased Rates of 30-Day Readmission Following Coronary Artery Bypass Graft Surgery
Fady Soliman, Alexis Okoh, Joshua Chao, Jigesh Baxi, Marlena E. Sabatino, Lauren Salgueiro, Mark Russo, Leonard Y. Lee
Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
Background: Frailty has recently come to prominence as predictive of poor outcomes following operative intervention. We evaluated the impact of frailty on 30-day readmission after coronary artery bypass graft (CABG) surgery.
Methods: This is a retrospective review of the prospectively maintained American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The database was interrogated to identify all patients who underwent CABG surgery. Patients were classified into Frail vs Non-frail based on the 5-item modified frailty index (5mFI). Baseline clinical and demographic characteristics were compared between Frail vs Non-Frail patients. The association between frailty and 30-day readmission was investigated using multivariable logistic regression models.
Results: A total of 3273 patients underwent CABG surgery in 2011 and 2012. The 5mFI classified 44% (n=1,437) of the patients as frail and the rate of 30-day readmission was documented in 4.9% (n=161) of all patients. Compared to non-frail patients, frail patients had a higher incidence of CHF, COPD, and were of worse functional status at baseline. In addition, frail patients had higher postoperative mortality (3.3% vs 1.6%, p=0.002), longer length of hospital stay (p<0.001) and greater likelihood of developing complications (p<0.001). After multivariate adjustment, frailty was found to be an independent predictor of 30-day readmission. OR:1.67, 95% C.I (1.20 to 2.32) p= 0.002.
Conclusion: The 5mFI identified more than one third of CABG patients as frail. Frail patients were at increased risk for adverse outcomes. There was a significant association between frailty and readmission within 30-days after CABG surgery.
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