Frailty and Geriatric Syndromes in Vascular Surgical Ward Patients

Prudence J. McRae, Philip J. Walker, Nancye M. Peel, Denise Hobson, Fiona Parsonson, Peter Donovan, Michael C. Reade, Louise Marquart, Alison M. Mudge

Pre-operative frailty is an important predictor of poor outcomes but the relationship between frailty and geriatric syndromes is less clear. The aims of this study were to describe the prevalence of frailty and incidence of geriatric syndromes in a cohort of older vascular surgical patients; and investigate the association of frailty and other key risk factors with the occurrence of one or more geriatric syndromes (delirium, functional decline, falls and/or pressure ulcers) and two hospital outcomes (acute length of stay and discharge destination). This prospective cohort study was conducted in a vascular surgical ward in a tertiary teaching hospital in Brisbane, Australia. Consecutive patients aged ≥ 65 years, admitted for ≥72 hours were eligible for inclusion. Frailty was defined as one or more of functional dependency, cognitive impairment or nutritional impairment at admission. Delirium was identified using the Confusion Assessment Method and a validated chart extraction tool. Functional decline from admission to discharge was identified from daily nursing documentation of activities of daily living. Falls were identified according to documentation in the medical record cross-checked with the incident reporting system. Pressure ulcers, acute length of stay and discharge destination were identified by documentation in the medical record. Risk factors associated with geriatric syndromes, acute length of stay and discharge destination was assessed using multivariable logistic regression models. Of 110 participants, 43 (39%) were frail and geriatric syndromes occurred in 40 (36%). Functional decline occurred in 25% of participants, followed by delirium (20%), pressure ulcers (12%) and falls (4%). In multivariable logistic analysis, frailty (OR 6.7, 95% CI = 2.0-22.1, P = 0.002), non-elective admission (OR 7.2, 95% CI = 2.2-25.3, P = 0.002) higher physiological severity (OR 5.5, 95% CI = 1.1-26.8, P = 0.03) and operative severity (OR 4.6, 95% CI= 1.2-17.7, P = 0.03) increased the likelihood of any geriatric syndrome. Frailty was an important predictor of longer length of stay (OR 2.6, 95% CI = 1.0-6.8, P = 0.06) and discharge destination (OR 4.2, 95% CI = 1.2-13.8, P = 0.02). Non-elective admission significantly increased the likelihood of discharge to a higher level of care (OR 5.3, 95% CI =1.3-21.6, P = 0.02). Frailty and geriatric syndromes were common in elderly vascular surgical ward patients. Frail patients and non-elective admissions were more likely to develop geriatric syndromes, have a longer length of stay and be discharged to a higher level of care.