2023 FSA Podium and Poster Abstracts

P044: A PRE-OPERATIVE FRAILTY SCREEN TO IDENTIFY AT-RISK OLDER ADULTS AND POST-DISCHARGE REFERRAL FOR REHABILITATION
Connor J Voirin, DO; Michael Freidl, MD; Jason Widrich, MD, MS, MBA; Brian Celso, PhD, MBA; University of Florida College of Medicine-Jacksonville

Introduction/Background: Identifying at-risk groups for decline is integral to the mission of improving patient safety in the perioperative arena. Postoperative cognitive changes have persisted for up to 3 months and in some cases longer in older adults. The associated care only further burdens an already stressed health care system. During the preoperative assessment of surgery patients, it is important to measure the degree of frailty and any history of falls. The aim of this research was to evaluate a preoperative frailty screening. We also investigated frail trauma patients admitted for a Ground Level Fall (GLF) at home who were referred to rehabilitation after discharge.

Methods: Surgery patients 60 years old and older underwent a preoperative assessment for frailty, cognition, mood and substance use that consisted of the Hopkins Frailty Exam and the Mini-Cog during their Pre-anesthesia Testing visit. The Patient Health Questionnaire (PHQ-9) was used to screen for depressive symptoms and the Tobacco, Alcohol, Prescription Medication, and other Substance used to screen for substance misuse. Participants were tested at the one week postoperative recovery period with the 5-minute Montreal Cognitive Assessment (MOCA). In addition, we completed a chart review of Trauma patients discharged to home after a GLF. Data was collected from the Trauma registry between Jan 1, 2020 and Dec 31 2021. The variables of interest were age 65 plus, admission for a ground level fall, Injury Severity Score (ISS), final disposition (e.g., home, rehab, SNF), referral to the Brain and Spinal Cord Injury Program (BSCIP), and mortality.

Results: A total of 84 participants that consisted of 37 males (45.1%) and 45 female (54.9%) were included. The average age was 69.51 (SD = 7.39). The ethnicities included Asian (1.2%), Black (37.3%), Latino (1.2%), White (53.0%), and Other (7.2%). The Hopkins Frailty Index showed Non-frail (73.5%), Intermediately frail (20.5%), and Frail (6.0%). The Clock Drawing test revealed correct sequence (82.1%), correct position (76.8%), hands correct (82.1%). The PHQ-9 found no depression in 60.8% of the participants. Alcohol use of three or more drinks a day and three or more days using recreational drugs was 22.4% and 17.6%, respectively. None of the participants were diagnosed with a delirium postoperative delirium. The one week post-operative MOCA showed an average score of 23.99 (SD = 5.04) out of 30 total which was at the Mild Cognitive Impairment range. A total of 482 trauma patients were admitted for a GLF. The average age was 78 years old, with an average ISS of 9. Twelve patients were referred to the BSCIP. Fifty percent of the Trauma patients were discharged back home. Of those, 3% or 13 patients were referred to rehabilitation (one by the Trauma service) after discharge.

Discussion/Conclusions: Perioperative evaluation of frailty is imperative for frail older adults. Both pre-operative and post-operative referral to rehabilitation at the time of discharge is likely to be of benefit. Thus, there is the need for the development and implementation of pre-habilitation as well as rehabilitation that could potentially improve adverse outcomes in older frail surgery patients.