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Screening frail patients before surgery: JAMA release clearly lays out benefits of intervention

Rating

3 Star

Use of Frailty Screening Initiative before Surgery Associated with Reduced Risk of Death

Our Review Summary

Nurse during home visit with senior womanThis news release looks at a program to introduce a quality improvement initiative aimed at reducing complications and deaths among frail older adults undergoing major elective surgery.

The release contained a welcome summary of the findings–the quantified benefits are very clear. But we wanted to know more about the screening tool used to determine how frail patients were, as well as the implementation plans: Is this a brand-new concept, or are there similar efforts out there? How much did the program cost? The news release also could have been more clear about the limitations of the study, such as the lack of a control group.

 

Why This Matters

Given how successfully the intervention apparently worked to reduce deaths, this study is likely to be read with wide interest.

Criteria

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

This is a very strong point for the release. It states clearly that absolute reductions were seen before and after the intervention:  i.e.:  “overall 30-day mortality decreased from 1.6 percent (84 of 5,275 patients) to 0.7 percent (26 of 3,878 patients) after FSI implementation. Improvement was greatest among frail patients (12.2 percent to 3.8 percent), although mortality rates also decreased among the robust patients (1.2 percent to 0.3 percent).”

Does the news release adequately explain/quantify the harms of the intervention?

Not Applicable

Given that this was a study about a quality improvement initiative, we’ll rate this N/A. However, it might have been worth raising the question of whether the time and emphasis placed on this screening test by clinicians detracted from other work they could have been doing to improve patient care and outcomes.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

More was needed on the limitations of the study. For example, the abstract said that the causal connections between the use of the screening tool and mortality outcomes required “additional investigation” to be confirmed–but the news release contained no such important caveat.

And also from the study: “Most important, although we were able to control for frailty, we were unable to account for patients who screened as frail and did not undergo surgery. This limitation may be a source of significant selection bias, although it is clear that surgeons continued to operate on frail patients. Further research using a randomized controlled design will be necessary to establish the causal connection between the FSI and mortality outcomes.”

Does the news release commit disease-mongering?

Satisfactory

No obvious disease mongering in this release.

Does the news release identify funding sources & disclose conflicts of interest?

Satisfactory

We learn that the study “was supported by a grant from the U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. We did not detect any conflicts of interest that should have been disclosed.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

The release mentions no alternatives to this screening program but presumably there are other methods and techniques that are used to reduce harm done on frail people who undergo elective surgery. Since this is a “before-after” trial presumably there would be some kind of frailty assessment, even an informal one, that happens prior to surgery?

Does the news release establish the availability of the treatment/test/product/procedure?

Not Satisfactory

It is not clear if the screening index and action plans for surgery among frail patients are readily available for other institutions to use.

Does the news release establish the true novelty of the approach?

Satisfactory

The release establishes what’s novel by stating: ““This study reveals the feasibility of facility-wide frailty screening in elective surgical populations.” We would have liked a bit more information on the risk analysis indicator used to assess frailty–is this a well-established tool or being used uniquely here?

Total Score: 5 of 9 Satisfactory

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