VA Nebraska-Western Iowa Health Care System
NEWS RELEASE: Frailty Screening Study at Omaha VAMC Shows Improved Post-Operative Results
December 30, 2016
Office of Public Affairs
Contact: Will Ackerman, Director, Communication & Voluntary Service
Office: (402) 995-4719 Cell: (402) 332-6780
FOR IMMEDIATE RELEASE
OMAHA, Neb. — A surgeon at the Omaha VA Medical Center designed and implemented a Frailty Screening Initiative (FSI) of preoperative patients that aimed to improve post-operative survival.
Dr. Jason Johanning was the chief of surgery for the VA Nebraska-Western Iowa Health Care System in 2011 when he implemented the cohort study that included more than 9,000 patients who had major, elective, and non-cardiac surgeries at the Omaha VA Medical Center between Oct. 1, 2007, and July 1, 2014. Johanning is currently the Surgical Clinical Line director for the VA Midwest Healthcare Network.
Dr. Daniel Hall, M.D., a surgeon at the Pittsburgh, PA, VA Medical Center, authored the study findings that were published in ‘JAMA Surgery’ Nov. 30.
The initiative consisted of two parts: screening for frailty with the goal of rapid assessment without the need for access to the patient’s medical chart, and review of surgical decision-making.
The study assessed the impact of the frailty screening on mortality and complications by comparing surgical outcomes before and after implementation. The primary outcome measure was post-operative mortality at 30, 180 and 365 days.
The study showed that overall, 30-day mortality dropped from 1.6 percent to 0.7 percent after FSI implementation. Improvement was greatest among the frail (from 12 percent to 4 percent). More significantly, the magnitude of improvement among frail patients increased at 180 (24 percent to 8 percent) and 365 days (35 percent to 12 percent).
The study showed that after controlling for age, frailty and predicted mortality, multivariate models showed that the screening resulted in a three-fold survival benefit.
One of the key drivers for initiating the study was to improve surgical outcomes for aging and an increasingly frail U.S. and veteran population. The study proves that frailty screening of preoperative patients is feasible, and may be an effective and scalable tool to improve surgical outcomes.
Many patients older than 65 undergo surgery. Recent data demonstrate that frailty is a more-powerful predictor of increased perioperative mortality, morbidity and cost than predictions based upon age or comorbidity alone.
The surgeons at the Omaha VA Medical Center perform 3,600 operations annually, of which 42 percent are 65 years of age or older.
Colleagues at the Omaha VA Medical Center who participated in the initiative include Dr. Mark Carlson; Tammy Bockman, RN, Kendra Schmid, PhD; Travis Bailey; and Georgia Purviance, RN.
Additional participants include Dr. Thomas G. Lynch, former chief of surgery and chief of staff at the Omaha VAMC, and currently the VA’s Assistant Deputy Under Secretary for Health for Clinical Operations; and Dr. Shipra Arya, a researcher and physician at the Atlanta, Ga., VA Health Care System.
About VA Nebraska-Western Iowa Health Care System
The VA NWIHCS is a Joint Commission-accredited, level-1c facility, which consists of a tertiary medical center in Omaha, Neb., and two larger clinics in Lincoln and Grand Island – which includes a community living center – five community-based outpatient clinics (CBOC) and one contract clinic. VA NWIHCS is part of the VA Midwest Health Care Network (VISN 23), which serves an estimated veteran population of 161,000 in 101 counties in Nebraska, western Iowa, Kansas and Missouri with an estimated 593,000 annual outpatient visits, and an operating budget of $334 million as of October 2014.