RESULTS Severity of frailty syndrome significantly correlated with post-surgical mortality rates and with many although not all post-surgical complications .
These relationships emerge in different type of surgical procedures and patients ' features .
BACKGROUND Frailty is a geriatric syndrome characterized by the clinical presentation of identifiable physical alterations and decreased physiological reserve .
The assessment of frailty syndrome has been recently related with post-surgical outcomes and overall mortality in older individuals .
Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study.
BACKGROUND The National Veterans Affairs Surgical Risk Study was design ed to collect reliable , valid data on patient risk and outcomes for major surgery in the Veterans Health Administration and to report comparative risk-adjusted postoperative mortality rates for surgical services in Veterans Health Administration . STUDY DESIGN This cohort study was conducted in 44 Veterans Affairs Medical Centers . Included were 87,078 major noncardiac operations performed under general , spinal , or epidural anesthesia between October 1 , 1991 , and December 31 , 1993 . The main outcomes measure was all-cause mortality within 30 days after the index procedure . Multivariable logistic regression risk-adjustment models for all operations and for eight surgical subspecialties were developed . Risk-adjusted surgical mortality rates were expressed as observed-to-expected ratios and were compared with unadjusted 30-day postoperative mortality rates . RESULTS Patient risk factors predictive of postoperative mortality included serum albumin level , American Society of Anesthesia class , emergency operation , and 31 additional preoperative variables . Considerable variability in unadjusted mortality rates for all operations was observed across the 44 hospitals ( 1.2 - 5.4 % ) . After risk adjustment , observed-to-expected ratios ranged from 0.49 to 1.53 . Rank order correlation of the hospitals by unadjusted and risk-adjusted mortality rates for all operations was 0.64 . Ninety-three percent of the hospitals changed rank after risk adjustment , 50 % by more than 5 and 25 % by more than 10 . CONCLUSIONS The Department of Veterans Affairs has successfully implemented a system for the prospect i ve collection and comparative reporting of risk-adjusted postoperative mortality rates after major noncardiac operations . Risk adjustment had an appreciable impact on the rank ordering of the hospitals and provided a means for monitoring and potentially improving the quality of surgical care
RESULTS Severity of frailty syndrome significantly correlated with post-surgical mortality rates and with many although not all post-surgical complications .
These relationships emerge in different type of surgical procedures and patients ' features .
BACKGROUND Frailty is a geriatric syndrome characterized by the clinical presentation of identifiable physical alterations and decreased physiological reserve .
The assessment of frailty syndrome has been recently related with post-surgical outcomes and overall mortality in older individuals .