We seek the Institute on Aging Small Research Grant Program Award. The proposal, entitled "Older Adult Safety in Surgery (OASIS) II", focuses on the role of self-reported physical functional status compared with Fried Frailty Criteria for the purpose of preoperative risk stratification in older adults undergoing major surgery. Current methods for identifying which patients will have an adverse postoperative course - i.e. the process of risk stratification - rely on inventories of comorbid disease that do ot account for disease severity or burden. In addition, these methods focus on discrete medical complications and not on major complications as a whole, discharge to nursing home, or readmission, which are the outcomes most important to patients and policymakers. Recently, multiple aging investigators have attempted to develop improved assessment methods for identifying older adults at risk for adverse postoperative course. They have shown an association between frailty and increased need for discharge to nursing home after surgery. Given the need to make point of care physical performance measurements and record time intensive inventories of exhaustion symptoms and activity items, frailty remains a suboptimal method for risk stratifying older adult surgical patients. Assessing self-reported functional stats offers the ability to efficiently capture a wide range of vulnerability to an adverse postoperative course. Investigators at Boston University with the support of the National Institute on Aging (NIA) have developed a tool for assessing physical function, the Late Life Function (LL-F) part of the Late Life Function and Disability Instrument which may be applied in the preoperative setting. From a large bank of potential items, a computer adaptive testing version of this instrument uses a patient's initial responses to guide subsequent inquiry (e.g. omitting questions of lower function for someone who's already reported high function). In this proposal, I will prospectively collect Fried Frailty Criteria and LL-F from patients visiting the Pre-procedure Clinic at Boston Medical Center. To track outcomes, I will leverage data already being collected by the Department of Surgery as part of a quality initiative sponsored by the American College of Surgeons National Surgical Quality Improvement Program. Comparing LL-F via computer adaptive testing with frailty head-to-head can clarify the path we should take regarding preoperative risk stratification. This proposal captures the unique experiences of the PI who has been leading medical consultation at the largest safety net institution in New England. It also includes the expertise of multiple leaders in aging research.
Despite major improvements in surgical care, many older adults remain vulnerable to an adverse postoperative course including major medical complications, discharge to nursing home, and readmission. Current methods for identifying which patients will have an adverse course - i.e. the process of risk stratification are suboptimal Comparing self-reported physical function using the Late Life Function and Disability Instrument with frailty head-to-head can clarify the path we should take to improve preoperative risk stratification.
|Kapoor, Alok; Chew, Priscilla; Silliman, Rebecca A et al. (2013) Venous thromboembolism after joint replacement in older male veterans with comorbidity. J Am Geriatr Soc 61:590-601|