Frailty Predicts Failure to Rescue after Thoracoabdominal Operation

Background An association between frailty and mortality exists; we hypothesized this is secondary to failure to rescue (F2R). Study Design Data were obtained from the NSQIP (2005 to 2012) for patients undergoing thoracoabdominal operations. Using the Modified Frailty Index, patients were classified as not (0 points), mildly (1 point), moderately (2 points), and severely (≥3) frail. Results There were 962,913 patients included; a majority were non-frail (52.2%), followed by mildly frail (33.8%). Complications were noted in 15.3%, major complications in 9.5%, mortality in 1.8%, and F2R in 1.3% of patients. On multivariate analysis, increases in frailty were associated with an increase in the risk of major complications (mildly: risk ratio [RR] 1.51; moderately: RR 2.69; and severely frail: RR 5.63 compared with non-frail; p Conclusions Increases in frailty independently predict risk for F2R. The greatest predictors of F2R in the Modified Frailty Index are those associated with disability and not comorbidities.