Abstract 12686: Frailty is Associated With Perioperative Major Adverse Cardiovascular Events After Non-Cardiac Surgery

Abstract

Introduction: Frailty is increasingly recognized for its association with adverse outcomes after surgery, but its excess risks have not been characterized in large representative cohorts. We investigated the prevalence of frailty and the associated incidence of major adverse cardiovascular events (MACE) among those hospitalized for non-cardiac surgery. Methods: Adults aged ≥45 years hospitalized for non-cardiac surgery between 2004-2014 were identified from the Healthcare Cost and Utilization Project’s National Inpatient Sample. A validated Hospital Frailty Risk Score (HFRS) based on International Classification of Diseases codes was used to classify patients as low (<5), medium (5-15), or high (>15) frailty risk. The primary outcome was MACE, defined as in-hospital mortality, myocardial infarction, and cardiac arrest. Multivariable logistic regression was used to estimate the adjusted odds of MACE by HFRS. Results: A total of 55,349,978 hospitalizations were identified, of which 81%, 18%, and 1% had low, medium, and high HFRS, respectively. Patients with higher HFRS had a greater burden of cardiovascular risk factors and comorbidities (Table). MACE occurred during 2.5% of all hospitalizations and was more common in patients with higher HFRS (high: 8.4%, medium: 7.4%, low: 1.3%, p<0.001). Compared to low HFRS, medium (adjusted odds ratio [aOR] 2.34, 95% CI 2.31-2.38) and high (aOR 2.49, 95% CI 2.42-2.56) HFRS were associated with greater odds of MACE. The association between high (versus low) HFRS and MACE was consistent across age groups (aOR 4.26 [95% CI 3.96 - 4.57] for ages 45-64, aOR 2.64 [95% CI 2.51 - 2.79] for ages 65-74, and aOR 2.80 [95% CI 2.72 - 2.89] for ages ≥75). Conclusion: Higher frailty scores are associated with increased risks of MACE overall and within age subgroups. Implementation of HFRS as a standardized, electronic health record-based screening tool may identify frail surgical inpatients at risk for adverse perioperative outcomes.