Failure to rescue in frail surgical patients

未能抢救体弱的手术患者

• 批准号: 9654366
• 负责人: Shipra Arya
• 金额: $ 11.7万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9654366
• 关键词: Failure; rescue; frail; surgical; patients

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.

GEMSSTAR R 03摘要 虚弱是储备减少和功能下降的发生，导致脆弱性和贫穷。 从压力源中恢复的结果通常在老年患者中。虽然虚弱与年龄不同，但它是高度 相关，随着美国人口老龄化，虚弱的患病率可能会增加。日益盛行 老年患者和体弱患者对外科服务的需求将更大。三分之一的患者 65-85岁的人在生命的最后一年将接受大手术。提供最好的质量， 因此，医疗保健提供者和医院必须制定战略，以满足这些日益增长的需求。 以满足需求，并确保为老年外科病人提供更高质量的护理。最近的数据表明， 是各种手术人群围手术期死亡率、发病率和成本增加的有力预测因素。 抢救失败（FTR）是指在住院期间未能防止可治疗并发症导致的死亡 (e.g.手术后大出血），并用于医院质量的度量。 我们的研究旨在表明，虚弱影响抢救失败的独立于其他医院因素。我们也 我认为某些医院较擅长抢救体弱病人，我们的目的是找出这些医院的特点， 医院的尽管很直观，但迄今为止尚未对这种关联进行研究。这将是第一个研究 虚弱（主要是患者特征）和FTR（被认为是 医院依赖该提案还要求制定一项详细的专业发展计划， 对于成功完成这项研究和Arya博士的职业发展至关重要， 向老龄化和手术质量研究过渡。这项研究的重大发现将改变失败的方式， 拯救研究用于医院质量，并为开发新的干预措施奠定基础 或关于患者以及医院水平的协议，以改善虚弱患者的手术结果。

项目成果

Assessment of the Risk Analysis Index for Prediction of Mortality, Major Complications, and Length of Stay in Patients who Underwent Vascular Surgery.

• DOI: 10.1016/j.avsg.2020.01.015
• 发表时间: 2020-07
• 期刊: Annals of vascular surgery
• 影响因子: 1.5
• 作者: Rothenberg KA;George EL;Trickey AW;Barreto NB;Johnson TM 2nd;Hall DE;Johanning JM;Arya S
• 通讯作者: Arya S

Recalibration and External Validation of the Risk Analysis Index: A Surgical Frailty Assessment Tool.

• DOI: 10.1097/sla.0000000000003276
• 发表时间: 2020-12
• 期刊: Annals of surgery
• 影响因子: 9
• 作者: Arya S;Varley P;Youk A;Borrebach JD;Perez S;Massarweh NN;Johanning JM;Hall DE
• 通讯作者: Hall DE

Association of peripheral artery disease with life-space mobility restriction and mortality in community-dwelling older adults.

• DOI: 10.1016/j.jvs.2019.08.276
• 发表时间: 2020-06
• 期刊: Journal of vascular surgery
• 影响因子: 4.3
• 作者: Arya S;Khakharia A;Rothenberg KA;Johnson TM 2nd;Sawyer P;Kennedy RE;Brown CJ;Bowling CB
• 通讯作者: Bowling CB

Comparison of Surgeon Assessment to Frailty Measurement in Abdominal Aortic Aneurysm Repair.

• DOI: 10.1016/j.jss.2019.11.005
• 发表时间: 2020-04
• 期刊: The Journal of surgical research
• 作者: George EL;Kashikar A;Rothenberg KA;Barreto NB;Chen R;Trickey AW;Arya S
• 通讯作者: Arya S