Abstract
Purpose :
Frailty is a state of diminished physiological reserve limiting resolution of homeostasis following a stressor. Frailty is emerging as a powerful risk stratification tool that has been validated across multiple surgical specialties. This study tested the hypothesis that frailty is a risk-factor for perioperative complications following open globe injury (OGI) in the geriatric population.
Methods :
This population-level retrospective study analyzed all cases of OGI among geriatric patients (>/= 65 years old) in the US within the Nationwide Inpatient Sample from 2002 to 2014. Patients were dichotomized as either “frail” or “non-frail” using the previously-validated Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnosis indicator. Baseline characteristics, ocular complications, and clinical outcomes were compared based on frailty status. Multivariable regression tested the association of frailty with mortality and endophthalmitis.
Results :
9144 geriatric OGI patients were identified, 514 (5.6%) of whom were frail. Compared to their non-frail counterparts, frail patients were on average slightly older, (84.0 years vs 80.4 years, P<0.001), female-predominant (75% versus 61%, P<0.001), and of different racial profile (P<0.001). Enucleation rates were higher among frail patients (10.5% versus 7.3%, P=0.006), as were rates of endophthalmitis (3.1% versus 1.7%, P=0.022), in-hospital mortality (5.6% versus 1.7%, P<0.001), length of stay (mean LOS, 9.78 days vs 4.39 days, P<0.001), and total charges billed ($84,113 versus $39,911, P<0.001). Rates of orbital floor fracture, globe rupture, and phthisis were not significantly different. On multivariate analysis frailty was a significant independent predictor of endophthalmitis (odds ratio, OR 2.364, 95% CI 1.325-4.218) and in-hospital death (OR 4.244, 95% CI 2.772-6.499, P<0.001).
Conclusions :
Among the US geriatric population admitted for OGI (2002-2014), 5.6% had frailty-defining comorbidities. This cohort was slightly older (mean 84 years), predominantly female (75%), and at higher risk for enucleation (10.5%), endophthalmitis (3.1%), and in-hospital death (5.6%) while requiring greater hospital resources (mean LOS 9.78 days, mean total charges $84,113). Awareness of the impact of frailty on perioperative complications may facilitate risk stratification, perioperative planning, and allocation of resources for this high-risk population.
This is a 2021 ARVO Annual Meeting abstract.