Key result
The Operation Frailty Risk Score (OFRS) demonstrated the highest predictive performance for postoperative 90-day mortality (c-statistic 0.81) compared to other established risk scores.
Why the study?
Predicting preoperative frailty risk in emergency surgery is challenging with limited information, and this study aimed to externally validate a recently developed frailty risk prediction model using another hospital's data.
Does the Operation Frailty Risk Score (OFRS) improve prediction of postoperative 90-day mortality in elderly patients undergoing emergency surgery compared to other risk scores?
Cohort (n=1,557)
No
Does the Operation Frailty Risk Score (OFRS) improve prediction of postoperative 90-day mortality in elderly patients undergoing emergency surgery compared to other risk scores?
Effect estimate: c-statistic 0.81
The Operation Frailty Risk Score (OFRS) demonstrates superior predictive performance for 90-day mortality in elderly patients undergoing emergency surgery compared to traditional risk scores.
OFRS may aid preoperative risk stratification in elderly emergency surgery; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Predicting preoperative frailty risk in emergency surgery is difficult with limited information because preoperative evaluation is not commonly performed properly. A recent study attempted to predict preoperative frailty risk using only diagnostic and surgical codes that can be extracted from the electronic medical records system. OBJECTIVE: This study aimed to validate whether the prediction model of preoperative frailty risk presented in the previous study is well applied to other medical hospitals' data. METHODS: This is a retrospective cohort study including 1,557 patients (≥75 years old) who were admitted to a single institution for emergency operations between January 1, 2010, and December 31, 2019, for study analysis. The Charlson comorbidity index, Hospital Frailty Risk Score, and the recently developed Operation Frailty Risk Score (OFRS) were calculated using the patient's diagnostic and operation codes. The predictive performances of these calculated risk scores and the American Society of Anesthesiologists-Physical Status classification for postoperative 90-day mortality were compared by using the receiver operating characteristic curve analysis. FINDINGS: The predictive performance of the OFRS, Charlson comorbidity index, American Society of Anesthesiologists-Physical Status, and Hospital Frailty Risk Score for postoperative 90-day mortality was 0.81, 0.630, 0.699, and 0.549 on a c-statistics basis, respectively. CONCLUSIONS: The OFRS using diagnostic and operation codes may show the best predictive performance for 90-day mortality compared to other risk scores, and it can be the clinically applicable model to evaluate the preoperative frailty risk in elderly patients undergoing emergency surgery.
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Lee et al. (2022) conducted a cohort in elderly patients undergoing emergency surgery (n=1,557). Operation Frailty Risk Score (OFRS) vs. Charlson comorbidity index, American Society of Anesthesiologists-Physical Status, and Hospital Frailty Risk Score was evaluated on postoperative 90-day mortality (c-statistic 0.81). The Operation Frailty Risk Score (OFRS) demonstrated the highest predictive performance for postoperative 90-day mortality (c-statistic 0.81) compared to other established risk scores.
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