TY - JOUR
T1 - Association of Frailty and the Expanded Operative Stress Score with Preoperative Acute Serious Conditions, Complications, and Mortality in Males Compared to Females
T2 - A Retrospective Observational Study
AU - Yan, Qi
AU - Kim, Jeongsoo
AU - Hall, Daniel E.
AU - Shinall, Myrick C.
AU - Reitz, Katherine Moll
AU - Stitzenberg, Karyn B.
AU - Kao, Lillian S.
AU - George, Elizabeth L.
AU - Youk, Ada
AU - Wang, Chen Pin
AU - Silverstein, Jonathan C.
AU - Bernstam, Elmer V.
AU - Shireman, Paula K.
N1 - Funding Information:
Funding/Support: This research was supported by grant U01TR002393 (J.K., D.E.H., K.B.S., L.S.K., C.P.W., J.C.S., E.V.B., and P.K.S.), from the National Center for Advancing Translational Sciences and the Office of the Director, NIH; grant K12CA090625 (M.C.S.) from the National Cancer Institute, NIH; grant K76AG068436 (M.C.S.) and L30AG064730 (K.M.R.) from the National Institute on Aging, NIH; grant 5T32HL0098036 (K.M.R.) from the National Heart, Lung, and Blood Institute, NIH and Clinical Translational Science Awards UL1TR002489 (University of North Caroline), UL1TR001857 (University of Pittsburgh), UL1TR003167 (University of Texas Health Science Center Houston) and UL1TR002645 (University of Texas Health San Antonio) from the National Center for Advancing Translational Sciences, NIH. Funds were also provided by the Veterans Affairs Center for Innovation to Implementation research fellowship funding (E.L.G.) from Health Services Research and Development.
Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - Objective: The aim of this study was to expand Operative Stress Score (OSS) increasing procedural coverage and assessing OSS and frailty association with Preoperative Acute Serious Conditions (PASC), complications and mortality in females versus males. Summary Background Data: Veterans Affairs male-dominated study showed high mortality in frail veterans even after very low stress surgeries (OSS1). Methods: Retrospective cohort using NSQIP data (2013-2019) merged with 180-day postoperative mortality from multiple hospitals to evaluate PASC, 30-day complications and 30-, 90-, and 180-day mortality. Results: OSS expansion resulted in 98.2% case coverage versus 87.0% using the original. Of 82,269 patients (43.8% male), 7.9% were frail/very frail. Males had higher odds of PASC [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) = 1.21-1.41, P < 0.001] and severe/life-threatening Clavien-Dindo IV (CDIV) complications (aOR = 1.18, 95% CI = 1.09-1.28, P < 0.001). Although mortality rates were higher (all time-points, P < 0.001) in males versus females, mortality was similar after adjusting for frailty, OSS, and case status primarily due to increased male frailty scores. Additional adjustments for PASC and CDIV resulted in a lower odds of mortality in males (30-day, aOR = 0.81, 95% CI = 0.71-0.92, P = 0.002) that was most pronounced for males with PASC compared to females with PASC (30-day, aOR = 0.75, 95% CI = 0.56-0.99, P = 0.04). Conclusions: Similar to the male-dominated Veteran population, private sector, frail patients have high likelihood of postoperative mortality, even after low-stress surgeries. Preoperative frailty screening should be performed regardless of magnitude of the procedure. Despite males experiencing higher adjusted odds of PASC and CDIV complications, females with PASC had higher odds of mortality compared to males, suggesting differences in the aggressiveness of care provided to men and women.
AB - Objective: The aim of this study was to expand Operative Stress Score (OSS) increasing procedural coverage and assessing OSS and frailty association with Preoperative Acute Serious Conditions (PASC), complications and mortality in females versus males. Summary Background Data: Veterans Affairs male-dominated study showed high mortality in frail veterans even after very low stress surgeries (OSS1). Methods: Retrospective cohort using NSQIP data (2013-2019) merged with 180-day postoperative mortality from multiple hospitals to evaluate PASC, 30-day complications and 30-, 90-, and 180-day mortality. Results: OSS expansion resulted in 98.2% case coverage versus 87.0% using the original. Of 82,269 patients (43.8% male), 7.9% were frail/very frail. Males had higher odds of PASC [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) = 1.21-1.41, P < 0.001] and severe/life-threatening Clavien-Dindo IV (CDIV) complications (aOR = 1.18, 95% CI = 1.09-1.28, P < 0.001). Although mortality rates were higher (all time-points, P < 0.001) in males versus females, mortality was similar after adjusting for frailty, OSS, and case status primarily due to increased male frailty scores. Additional adjustments for PASC and CDIV resulted in a lower odds of mortality in males (30-day, aOR = 0.81, 95% CI = 0.71-0.92, P = 0.002) that was most pronounced for males with PASC compared to females with PASC (30-day, aOR = 0.75, 95% CI = 0.56-0.99, P = 0.04). Conclusions: Similar to the male-dominated Veteran population, private sector, frail patients have high likelihood of postoperative mortality, even after low-stress surgeries. Preoperative frailty screening should be performed regardless of magnitude of the procedure. Despite males experiencing higher adjusted odds of PASC and CDIV complications, females with PASC had higher odds of mortality compared to males, suggesting differences in the aggressiveness of care provided to men and women.
KW - Clavien-Dindo level IV
KW - health disparities
KW - present at the time of surgery
KW - sex-related mortality
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U2 - 10.1097/SLA.0000000000005027
DO - 10.1097/SLA.0000000000005027
M3 - Article
C2 - 34183515
AN - SCOPUS:85146162908
SN - 0003-4932
VL - 277
SP - E294-E304
JO - Annals of Surgery
JF - Annals of Surgery
IS - 2
ER -