Table 2. Multivariable Logistic Regression Models Evaluating the Association Between Frailty and Mortality Stratified by Specialtya.
| Specialty | Model | aOR (95% CI) | ||
|---|---|---|---|---|
| NSQIP, 30-d mortality | VASQIP, 30-d mortality | VASQIP, 180-d mortality | ||
| General | RAI robust | 0.17 (0.16-0.18) | 0.33 (0.28-0.40) | 0.31 (0.28-0.34) |
| RAI normal | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| RAI frail | 3.41 (3.29-3.55) | 4.15 (3.67-4.71) | 4.32 (4.02-4.65) | |
| RAI very frail | 10.3 (9.77-10.86) | 15.48 (13.63-17.59) | 15.86 (14.53-17.31) | |
| OSS 1-2 | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| OSS 3 | 3.91 (3.71-4.12) | 4.32 (3.72-5.02) | 2.82 (2.62-3.05) | |
| OSS 4-5 | 6.42 (6.07-6.79) | 5.76 (4.89-6.78) | 3.8 (3.47-4.15) | |
| Emergency | 5.6 (5.42-5.78) | 3.6 (3.27-3.98) | 2.61 (2.44-2.80) | |
| Gynecologyb | RAI robust | 0.07 (0.05-0.10) | ||
| RAI normal | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| RAI frail | 3.8 (2.47-5.86) | |||
| RAI very frail | 18.29 (9.92-33.74) | |||
| OSS 1-2 | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| OSS 3 | 1.63 (1.06-2.50) | 0.98 (0.06-16.06) | 0.96 (0.19-4.78) | |
| OSS 4-5 | 4.72 (2.55-8.73) | |||
| Emergency | 4.25 (2.36-7.66) | 185.6 (11.26-3058.58) | 37.08 (4.17-329.93) | |
| Neurosurgery | RAI robust | 0.36 (0.30-0.43) | 0.29 (0.16-0.49) | 0.34 (0.26-0.43) |
| RAI normal | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| RAI frail | 4.18 (3.58-4.89) | 5.22 (3.43-7.96) | 6.82 (5.53-8.39) | |
| RAI very frail | 9.8 (7.68-12.50) | 32.1 (20.95-49.16) | 30.54 (23.34-39.97) | |
| OSS 1-2 | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| OSS 3 | 4.46 (3.59-5.52) | 1.28 (0.88-1.86) | 1.93 (1.58-2.35) | |
| OSS 4-5 | 18.21 (13.77-24.09) | 2.48 (1.37-4.51) | 1.86 (1.23-2.80) | |
| Emergency | 3.73 (3.11-4.47) | 1.58 (1.01-2.48) | 1.12 (0.83-1.51) | |
| Orthopedicb | RAI robust | 0.2 (0.17-0.23) | 0.27 (0.20-0.38) | 0.31 (0.27-0.36) |
| RAI normal | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| RAI frail | 7.12 (6.49-7.82) | 8.84 (7.12-11.00) | 9.06 (8.05-10.20) | |
| RAI very frail | 20.31 (17.79-23.18) | 33.94 (27.12-42.46) | 36.8 (32.18-42.07) | |
| OSS 1-2 | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| OSS 3 | 3.41 (3.05-3.81) | 2.28 (1.89-2.75) | 2.35 (2.12-2.61) | |
| OSS 4-5 | 39.66 (10.54-149.19) | |||
| Emergency | 2.46 (2.23-2.71) | 1.79 (1.44-2.23) | 1.7 (1.46-1.97) | |
| ENT | RAI robust | 0.21 (0.12-0.34) | 0.3 (0.12-0.74) | 0.38 (0.28-0.52) |
| RAI normal | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| RAI frail | 3.83 (2.37-6.21) | 5.3 (2.89-9.69) | 3.33 (2.58-4.30) | |
| RAI very frail | 15.74 (8.35-29.68) | 7.81 (3.44-17.73) | 6.27 (4.33-9.07) | |
| OSS 1-2 | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| OSS 3 | 2.36 (1.51-3.68) | 2.82 (1.58-5.02) | 2.95 (2.31-3.76) | |
| OSS 4-5 | 5.15 (2.92-9.09) | 3.04 (1.42-6.51) | 5.38 (4.03-7.17) | |
| Emergency | 7.89 (3.94-15.83) | 4.25 (1.79-10.05) | 3.62 (2.27-5.77) | |
| Plastic | RAI robust | 0.09 (0.05-0.16) | 0.52 (0.16-1.63) | 0.36 (0.20-0.64) |
| RAI normal | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| RAI frail | 5.1 (3.03-8.58) | 3.68 (1.21-11.21) | 7.13 (4.35-11.69) | |
| RAI very frail | 27.99 (14.67-53.39) | 14.15 (4.19-47.77) | 24.77 (13.38-45.88) | |
| OSS 1-2 | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| OSS 3 | 1.53 (0.96-2.42) | 2.53 (1.01-6.29) | 1.46 (0.94-2.27) | |
| OSS 4-5 | 24.94 (6.13-101.45) | 9.02 (1.02-79.89) | 6.58 (1.56-27.77) | |
| Emergency | 7.44 (4.10-13.51) | 3.33 (0.93-11.91) | 0.91 (0.35-2.41) | |
| Thoracic | RAI robust | 0.3 (0.23-0.37) | 0.5 (0.33-0.75) | 0.54 (0.44-0.65) |
| RAI normal | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| RAI frail | 2.05 (1.71-2.45) | 2.87 (2.14-3.84) | 2.88 (2.45-3.38) | |
| RAI very frail | 9.98 (7.63-13.05) | 9.48 (6.96-12.92) | 6.42 (5.19-7.93) | |
| OSS 1-2 | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| OSS 3 | 1.35 (1.00-1.81) | 1.48 (1.00-2.20) | 0.8 (0.66-0.97) | |
| OSS 4-5 | 1.36 (1.03-1.80) | 1.36 (0.96-1.93) | 0.65 (0.44-0.76) | |
| Emergency | 3.65 (2.79-4.79) | 1.4 (0.93-2.10) | 1.16 (0.87-1.55) | |
| Urology | RAI robust | 0.33 (0.25-0.43) | 0.36 (0.23-0.56) | 0.39 (0.33-0.47) |
| RAI normal | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| RAI frail | 6.14 (5.20-7.24) | 4.35 (3.33-5.70) | 5.01 (4.50-5.58) | |
| RAI very frail | 27.41 (21.56-34.85) | 30.47 (22.56-41.15) | 23.07 (19.52-27.27) | |
| OSS 1-2 | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| OSS 3 | 0.95 (0.78-1.15) | 1.53 (1.09-2.15) | 0.8 (0.66-0.96) | |
| OSS 4-5 | 2.63 (2.21-3.13) | 3.13 (2.34-4.18) | 1.51 (1.31-1.76) | |
| Emergency | 4.28 (3.27-5.60) | 6.46 (4.43-9.42) | 3.41 (2.65-4.40) | |
| Vascular | RAI robust | 0.41 (0.37-0.45) | 0.52 (0.38-0.71) | 0.5 (0.42-0.59) |
| RAI normal | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| RAI frail | 3.42 (3.19-3.67) | 4.23 (3.51-5.10) | 4.2 (3.79-4.65) | |
| RAI very frail | 10.85 (9.83-11.96) | 12.66 (10.31-15.55) | 12.76 (11.25-14.48) | |
| OSS 1-2 | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| OSS 3 | 1.18 (1.10-1.26) | 1.3 (1.07-1.57) | 1.06 (0.95-1.17) | |
| OSS 4-5 | 3.25 (2.91-3.64) | 3.46 (2.59-4.63) | 1.45 (1.19-1.78) | |
| Emergency | 5.83 (5.46-6.23) | 3.35 (2.78-4.04) | 2.33 (2.05-2.64) | |
Abbreviations: aOR, adjusted odds ratio; ENT, ear, nose, and throat; NSQIP, National Surgical Quality Improvement Program; OSS, Operative Stress Score; RAI, Risk Analysis Index; VASQIP, Veterans Affairs Surgical Quality Improvement Program.
a
Frailty was measured with the RAI, which uses 14 variables from the registry data set to generate scores ranging from 0 to 81, with higher scores indicating more frailty. There are 4 levels: robust (≤20), normal (21-29), frail (30-39), and very frail (≥40); the reference group is normal. The OSS categories are 1 to 2 (low stress), 3 (moderate stress), and 4 to 5 (high stress); reference group is OSS 1 to 2. Emergency was categorized as yes or no and emergent or nonemergent; reference group was nonemergent.
b
Empty cells indicate that the factors could not be estimated in the model.