The Frailty Risk Score predicts length of stay and need for rehospitalization after kidney transplantation in a retrospective cohort: a pilot study

Abstract Background Frailty is a widely used measure in older patients as a predictor of poor outcomes after hospitalization and surgery. There is a growing body of data in kidney transplantation suggesting frailty can predict adverse outcomes. There is interest in using chart review measures of fra...

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Main Authors: Joanna Schaenman, Loren Castellon, Emily C. Liang, Deepa Nanayakkara, Basmah Abdalla, Catherine Sarkisian, Deena Goldwater
Format: Article
Language:English
Published: BMC 2019-12-01
Series:Pilot and Feasibility Studies
Subjects:
Online Access:https://doi.org/10.1186/s40814-019-0534-2
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spelling doaj-cc0a388024fc43f7ba668b4a1d7164482020-12-13T12:13:08ZengBMCPilot and Feasibility Studies2055-57842019-12-01511910.1186/s40814-019-0534-2The Frailty Risk Score predicts length of stay and need for rehospitalization after kidney transplantation in a retrospective cohort: a pilot studyJoanna Schaenman0Loren Castellon1Emily C. Liang2Deepa Nanayakkara3Basmah Abdalla4Catherine Sarkisian5Deena Goldwater6Division of Infectious Diseases, Department of Medicine, David Geffen School of MedicineAlbert Einstein College of MedicineDivision of Infectious Diseases, Department of Medicine, David Geffen School of MedicineDivision of Infectious Diseases, Department of Medicine, David Geffen School of MedicineDivision of Nephrology, Department of Medicine, David Geffen School of MedicineDivision of Geriatrics, Department of Medicine, David Geffen School of MedicineDivision of Geriatrics, Department of Medicine, David Geffen School of MedicineAbstract Background Frailty is a widely used measure in older patients as a predictor of poor outcomes after hospitalization and surgery. There is a growing body of data in kidney transplantation suggesting frailty can predict adverse outcomes. There is interest in using chart review measures of frailty and multimorbidity, as they may be equally predictive as physical measurement. This approach holds promise for patient evaluation, identifying candidates for prehabilitation, and targeting resources towards those anticipated to have an increased rate of clinical challenges after kidney transplantation. Frail patients who are often older may place a large resource and economic burden on transplant programs. Methods We applied a previously published chart review–based approach in a retrospective, pilot study to calculate the Frailty Risk Score (FRS) utilizing a cohort of kidney transplant patients. We reviewed concurrent comorbidities using the Charlson comorbidity (CM) score to determine the feasibility and utility of applying this approach in transplant patients to predict post-transplant outcomes such as length of hospitalization and the need for rehospitalization. Results Sixty kidney transplant recipients were evaluated by chart review, 23 characterized as older (> = 60) and 37 younger (ages 30–59). Median FRS score was 3 (range 1–7). Higher FRS was significantly associated with increased patient age (high FRS 19% in younger patients, 43% in older patients). Increased CM score was also associated with increased patient age. Patients with a high FRS stayed in the hospital for an average of 8 days, compared with 5.7 days for a low FRS. Patients with high FRS were readmitted an average of 2.9 times compared with an average of 1.1 for those with a low FRS. FRS score remained significant for predicting outcomes after adjustment for patient age. Conclusion Elevated FRS prior to transplantation was associated with increased hospital stay and the need for readmission in kidney transplant recipients. This analysis demonstrates the potential strength of chart review in evaluating frailty prior to transplantation, permitting risk stratification and targeting of resources for rehabilitation and close post-transplant monitoring. Frail patients may benefit from targeted “prehabilitation” to attenuate the associated adverse clinical outcomes.https://doi.org/10.1186/s40814-019-0534-2FrailtyKidney transplantationOlderComorbidityReadmission
collection DOAJ
language English
format Article
sources DOAJ
author Joanna Schaenman
Loren Castellon
Emily C. Liang
Deepa Nanayakkara
Basmah Abdalla
Catherine Sarkisian
Deena Goldwater
spellingShingle Joanna Schaenman
Loren Castellon
Emily C. Liang
Deepa Nanayakkara
Basmah Abdalla
Catherine Sarkisian
Deena Goldwater
The Frailty Risk Score predicts length of stay and need for rehospitalization after kidney transplantation in a retrospective cohort: a pilot study
Pilot and Feasibility Studies
Frailty
Kidney transplantation
Older
Comorbidity
Readmission
author_facet Joanna Schaenman
Loren Castellon
Emily C. Liang
Deepa Nanayakkara
Basmah Abdalla
Catherine Sarkisian
Deena Goldwater
author_sort Joanna Schaenman
title The Frailty Risk Score predicts length of stay and need for rehospitalization after kidney transplantation in a retrospective cohort: a pilot study
title_short The Frailty Risk Score predicts length of stay and need for rehospitalization after kidney transplantation in a retrospective cohort: a pilot study
title_full The Frailty Risk Score predicts length of stay and need for rehospitalization after kidney transplantation in a retrospective cohort: a pilot study
title_fullStr The Frailty Risk Score predicts length of stay and need for rehospitalization after kidney transplantation in a retrospective cohort: a pilot study
title_full_unstemmed The Frailty Risk Score predicts length of stay and need for rehospitalization after kidney transplantation in a retrospective cohort: a pilot study
title_sort frailty risk score predicts length of stay and need for rehospitalization after kidney transplantation in a retrospective cohort: a pilot study
publisher BMC
series Pilot and Feasibility Studies
issn 2055-5784
publishDate 2019-12-01
description Abstract Background Frailty is a widely used measure in older patients as a predictor of poor outcomes after hospitalization and surgery. There is a growing body of data in kidney transplantation suggesting frailty can predict adverse outcomes. There is interest in using chart review measures of frailty and multimorbidity, as they may be equally predictive as physical measurement. This approach holds promise for patient evaluation, identifying candidates for prehabilitation, and targeting resources towards those anticipated to have an increased rate of clinical challenges after kidney transplantation. Frail patients who are often older may place a large resource and economic burden on transplant programs. Methods We applied a previously published chart review–based approach in a retrospective, pilot study to calculate the Frailty Risk Score (FRS) utilizing a cohort of kidney transplant patients. We reviewed concurrent comorbidities using the Charlson comorbidity (CM) score to determine the feasibility and utility of applying this approach in transplant patients to predict post-transplant outcomes such as length of hospitalization and the need for rehospitalization. Results Sixty kidney transplant recipients were evaluated by chart review, 23 characterized as older (> = 60) and 37 younger (ages 30–59). Median FRS score was 3 (range 1–7). Higher FRS was significantly associated with increased patient age (high FRS 19% in younger patients, 43% in older patients). Increased CM score was also associated with increased patient age. Patients with a high FRS stayed in the hospital for an average of 8 days, compared with 5.7 days for a low FRS. Patients with high FRS were readmitted an average of 2.9 times compared with an average of 1.1 for those with a low FRS. FRS score remained significant for predicting outcomes after adjustment for patient age. Conclusion Elevated FRS prior to transplantation was associated with increased hospital stay and the need for readmission in kidney transplant recipients. This analysis demonstrates the potential strength of chart review in evaluating frailty prior to transplantation, permitting risk stratification and targeting of resources for rehabilitation and close post-transplant monitoring. Frail patients may benefit from targeted “prehabilitation” to attenuate the associated adverse clinical outcomes.
topic Frailty
Kidney transplantation
Older
Comorbidity
Readmission
url https://doi.org/10.1186/s40814-019-0534-2
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