GEMSSTAR R03 Abstract Frailty is the occurrence of decreased reserve and functional decline with resultant vulnerability and poor outcomes in recovery from a stressor usually in older patients. Although frailty is distinct from age, it is highly correlated, and as the US population ages, the prevalence of frailty will likely increase. The growing prevalence of older patient population and frailty will place greater demands on surgical services. One third of all patients aged 65-85 will undergo a major surgical procedure within the last year of life. To provide the best quality of care, it is imperative that healthcare providers and hospitals develop strategies to meet these growing demands and to ensure higher-quality care for geriatric surgical patients. Recent data demonstrate that frailty is a powerful predictor of increased perioperative mortality, morbidity and cost in various surgical populations. Failure to rescue (FTR) refers to a failure to prevent death from treatable complications during hospitalization (e.g. major hemorrhage after surgery) and is used a metric for hospital quality. Our study aims to show that frailty impacts failure to rescue independent of other hospital factors. We also think that certain hospitals are better at rescuing frail patients and we aim to identify characteristics of such hospitals. Although intuitive, this association has not been studied so far. This will be the first study to examine the interplay of frailty, which is primarily a patient characteristic, and FTR- a quality indicator believed to hospital dependent. The proposal also entails a detailed professional development plan with training that will be essential both for successful completion of this research and toward Dr. Arya's career development and transition to aging and surgical quality research. Significant findings from this study will change the way failure to rescue research is used for hospital quality and will lay the groundwork for development of new interventions or protocols on a patient as well as hospital level to improve surgical outcomes in frail patients.

Public Health Relevance

Relevance To Public Health Failure to rescue is a widely used metric for hospital quality comparisons and signifies the ability of hospitals to rescue patients from complications and avert death, while, frailty is a syndrome of decreased physiological reserve to survive an adverse event or complication after a stressor like surgery. This study will explore the association between frailty and failure to rescue in a growing aging surgical population and identify hospital characteristics that lead to better rescue rates in frail patients forming the groundwork for developing patient and hospital level protocols to improve the surgical care of frail patients and improve hospital quality. The associated professional development plan will serve as a platform for career development of the candidate as she transitions to independent investigator status.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Small Research Grants (R03)
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Special Emphasis Panel (ZAG1-ZIJ-3 (M1))
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Salive, Marcel
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Emory University
Schools of Medicine
United States
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Arya, Shipra; Khakharia, Anjali; Binney, Zachary O et al. (2018) Association of Statin Dose With Amputation and Survival in Patients With Peripheral Artery Disease. Circulation 137:1435-1446
Arya, Shipra; Binney, Zachary O; Khakharia, Anjali et al. (2018) High hemoglobin A1c associated with increased adverse limb events in peripheral arterial disease patients undergoing revascularization. J Vasc Surg 67:217-228.e1
Arya, Shipra; Lee, Sujin; Zahner, Greg J et al. (2018) The association of comorbid depression with mortality and amputation in veterans with peripheral artery disease. J Vasc Surg 68:536-545.e2
Hall, Daniel E; Arya, Shipra; Schmid, Kendra K et al. (2017) Association of a Frailty Screening Initiative With Postoperative Survival at 30, 180, and 365 Days. JAMA Surg 152:233-240
Hall, Daniel E; Arya, Shipra; Schmid, Kendra K et al. (2017) Development and Initial Validation of the Risk Analysis Index for Measuring Frailty in Surgical Populations. JAMA Surg 152:175-182