The VA National Surgical Quality Improvement Program (VASQIP) has ushered in quality improvements in intraoperative and postoperative care over the past 20 years. These improvements have been reduction in rates of cardiac complications, pulmonary complications, and venous thromboembolism. However, medical complications of surgery are still common, costly, and fatal. Conventional preoperative risk assessment has relied upon comorbidity indices, yet they have certain limitations. Better risk stratification of older adults through geriatric based assessments of physical function represents an untapped potential for further improvements. The Veteran-Rand-12 (VR-12) survey routinely distributed to veterans provides valuable information expressed as a summary physical component score (PCS) about functional limitation related to medical disease. We propose measuring the association of PCS with medical complications of surgery. OBJECTIVES Aim 1: Determine the independent association of PCS with discrete medical complications (cardiac, pulmonary, VTE, renal failure, and other complications) of multiple types of surgery (general, vascular, orthopedic, thoracic, and others). METHODS The research team will first identify patients 65 years and older who have undergone inpatient surgery from fiscal years 2007 until 2012 and who have data available from each of three data sources- namely, VA administrative data from Austin mainframe (Austin data), VASQIP, and PCS. The research team will measure multiple postoperative outcomes at 30 days spanning cardiac, pulmonary, VTE, surgical site infection, combinations of serious complications, and death. VASQIP postoperative outcome variables manually adjudicated by clinical reviewers will form the basis of these outcomes. After data preparation and linkage of PCS with surgical records, we will calculate descriptive statistics, cross tabular frequencies, and then multivariate regression (both logistic and Cox proportional hazards). ANTICIPATED IMPACT If the research conducted demonstrates a significant association between preoperative functional status and postoperative medical complications, this would compel the research team to continue this line of research by prospectively collecting more detailed functional status information. It would also begin to make the case for systematic measurement of functional status in older veterans undergoing surgery.
Despite landmark improvements in surgical outcomes, preoperative preparation of older veterans remains underdeveloped. Sentinel to preoperative preparation is risk stratification. Traditionally clinicians have relied on comorbidity indices but geriatric based assessments have emerged which permit more granular assessments of function. These include short form assessments such as the VR-12 distributed widely in the VA. We build on our prior work looking at risk of VTE in orthopedic patients by repeating measurements for multiple discrete medical complications of surgery across multiple types of surgery.