Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients

Muhammad Khan, Asad Azim, Terence OKeeffe, Faisal Jehan, Narong Kulvatunyou, Chelsey Santino, Andrew Tang, Gary Vercruysse, Lynn Gries, Bellal Joseph

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. Methods 3-year(2013–15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor. Geriatric-Rescue-After-Surgery(GRAS)-score calculated for each-patient. AUROC used to assess model discrimination. Results 725 EGS-patients analyzed. 44.6%(n = 324) had major-complications. The FTR-rate was 11.5%. Overall-mortality rate was 15.3%. On regression, significant-factors with their estimated-weights were:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2). AUROC of score was 0.787. Conclusion GRAS-score is first score based on preoperative assessment that can reliably predict FTR in EGS-GP. Preoperative identification of patients at increased-risk of FTR can help in risk-stratification and timely-mobilization of resources for successful rescue of these patients.

Original languageEnglish (US)
Pages (from-to)53-57
Number of pages5
JournalAmerican Journal of Surgery
Volume215
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Geriatrics
Emergencies
Weights and Measures
Chronic Obstructive Pulmonary Disease
Statistical Factor Analysis
Chronic Kidney Failure
Heart Failure
Odds Ratio
Regression Analysis
Mortality

Keywords

  • Emergency general surgery
  • Failure to rescue
  • Geriatric surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients. / Khan, Muhammad; Azim, Asad; OKeeffe, Terence; Jehan, Faisal; Kulvatunyou, Narong; Santino, Chelsey; Tang, Andrew; Vercruysse, Gary; Gries, Lynn; Joseph, Bellal.

In: American Journal of Surgery, Vol. 215, No. 1, 01.01.2018, p. 53-57.

Research output: Contribution to journalArticle

Khan, M, Azim, A, OKeeffe, T, Jehan, F, Kulvatunyou, N, Santino, C, Tang, A, Vercruysse, G, Gries, L & Joseph, B 2018, 'Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients', American Journal of Surgery, vol. 215, no. 1, pp. 53-57. https://doi.org/10.1016/j.amjsurg.2017.08.002
Khan, Muhammad ; Azim, Asad ; OKeeffe, Terence ; Jehan, Faisal ; Kulvatunyou, Narong ; Santino, Chelsey ; Tang, Andrew ; Vercruysse, Gary ; Gries, Lynn ; Joseph, Bellal. / Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients. In: American Journal of Surgery. 2018 ; Vol. 215, No. 1. pp. 53-57.
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abstract = "Background Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. Methods 3-year(2013–15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor. Geriatric-Rescue-After-Surgery(GRAS)-score calculated for each-patient. AUROC used to assess model discrimination. Results 725 EGS-patients analyzed. 44.6{\%}(n = 324) had major-complications. The FTR-rate was 11.5{\%}. Overall-mortality rate was 15.3{\%}. On regression, significant-factors with their estimated-weights were:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2). AUROC of score was 0.787. Conclusion GRAS-score is first score based on preoperative assessment that can reliably predict FTR in EGS-GP. Preoperative identification of patients at increased-risk of FTR can help in risk-stratification and timely-mobilization of resources for successful rescue of these patients.",
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T1 - Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients

AU - Khan, Muhammad

AU - Azim, Asad

AU - OKeeffe, Terence

AU - Jehan, Faisal

AU - Kulvatunyou, Narong

AU - Santino, Chelsey

AU - Tang, Andrew

AU - Vercruysse, Gary

AU - Gries, Lynn

AU - Joseph, Bellal

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N2 - Background Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. Methods 3-year(2013–15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor. Geriatric-Rescue-After-Surgery(GRAS)-score calculated for each-patient. AUROC used to assess model discrimination. Results 725 EGS-patients analyzed. 44.6%(n = 324) had major-complications. The FTR-rate was 11.5%. Overall-mortality rate was 15.3%. On regression, significant-factors with their estimated-weights were:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2). AUROC of score was 0.787. Conclusion GRAS-score is first score based on preoperative assessment that can reliably predict FTR in EGS-GP. Preoperative identification of patients at increased-risk of FTR can help in risk-stratification and timely-mobilization of resources for successful rescue of these patients.

AB - Background Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP. Methods 3-year(2013–15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS. Regression analysis used to analyze factors associated with FTR and natural-logarithm of significant odds-ratio used to calculate estimated-weights for each factor. Geriatric-Rescue-After-Surgery(GRAS)-score calculated for each-patient. AUROC used to assess model discrimination. Results 725 EGS-patients analyzed. 44.6%(n = 324) had major-complications. The FTR-rate was 11.5%. Overall-mortality rate was 15.3%. On regression, significant-factors with their estimated-weights were:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2). AUROC of score was 0.787. Conclusion GRAS-score is first score based on preoperative assessment that can reliably predict FTR in EGS-GP. Preoperative identification of patients at increased-risk of FTR can help in risk-stratification and timely-mobilization of resources for successful rescue of these patients.

KW - Emergency general surgery

KW - Failure to rescue

KW - Geriatric surgery

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