The VA Pittsburgh Healthcare System institutional review board determined this analysis to be exempt because data were deidentified; thus, no consent was needed. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE ) reporting guideline.
This cohort study used data from the Veterans Affairs Surgical Quality Improvement Program for noncardiac surgical procedures performed between April 1, 2010, and March 31, 2014, for veterans with available 1-year postoperative vital status. Exposures of interest were urgency (emergent vs elective), frailty (measured by the Risk Analysis Index [RAI]), and operative stress (measured by the Operative Stress Score [OSS]). Operative urgency was defined by the binary Veterans Affairs Surgical Quality Improvement Program variable for emergent operations. The RAI is based on the accumulation of deficits model of frailty and uses demographic factors (including age), comorbidities, cognitive decline, residence in a facility, and activities of daily living to quantify frailty, with higher scores indicating greater frailty (eFigure in theSupplement ).2 (link),3 (link),4 (link),5 (link) The OSS was developed using modified Delphi consensus methods to rate the 565 most common Current Procedural Terminology codes included in Veterans Affairs Surgical Quality Improvement Program on a scale of 1 to 5 by degree of physiologic stress experienced by patients, with higher scores indicating more stress (eTable in the Supplement ).1 (link) Patients were categorized as robust, normal, frail, and very fail by RAI score (RAI ≤20, 21-29, 30-39, and ≥40, respectively).1 (link),3 (link) The outcomes were mortality at 30, 90, and 180 days. P values were calculated at the 95% significance level. The χ2 test for trend was used to test for increasing mortality with increasing OSS level and frailty. All analyses were performed using STATA statistical software version 14 (StataCorp). Data analysis was performed from January 2020 to May 2020.
This cohort study used data from the Veterans Affairs Surgical Quality Improvement Program for noncardiac surgical procedures performed between April 1, 2010, and March 31, 2014, for veterans with available 1-year postoperative vital status. Exposures of interest were urgency (emergent vs elective), frailty (measured by the Risk Analysis Index [RAI]), and operative stress (measured by the Operative Stress Score [OSS]). Operative urgency was defined by the binary Veterans Affairs Surgical Quality Improvement Program variable for emergent operations. The RAI is based on the accumulation of deficits model of frailty and uses demographic factors (including age), comorbidities, cognitive decline, residence in a facility, and activities of daily living to quantify frailty, with higher scores indicating greater frailty (eFigure in the
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