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Roger K Henry, Aditya Uppuluri, Paul D Langer, Marco A Zarbin, Neelakshi Bhagat; The Impact of Frailty on Perioperative Outcomes after Open-Globe Injury in the Geriatric Population. Invest. Ophthalmol. Vis. Sci. 2021;62(8):681.
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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.
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.
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).
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.
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