Frail patients suffer disproportionally high rates of adverse postoperative complications, including death. Although frailty predicts postoperative outcomes better than age or comorbidity alone, surgeons do not routinely screen patients for frailty and have lacked an easily administered tool for point-of-care testing to inform real-time decision-making. Dr. Hall's innovative and simple assessment is now a Finalist in the VHA Shark Tank 2019 competition.

Congratulations to CHERP Investigator and VA Surgeon Daniel E. Hall, MD, M.Div, M.H.Sc., whose practice, Pre-operative Frailty Screening and Prehabilitation, has been selected as a Finalist in the 2019 VHA Shark Tank Competition.  Diffusion of Excellence program evaluators reviewed 100 Semifinalists and selected 15 finalists. Dr. Hall will deliver a two-minute “pitch” to Medical Center and VISN Director “Sharks” at the competition on October 22 in Washington DC.  The “Sharks” bid resources to support implementation of the practice at their sites. 

Dr. Hall’s Innovation Practice developed from his successful work with the Risk Analysis Index (RAI) to assess frailty among Veterans considering elective surgery. When the RAI was tested at the Omaha VAMC, 180-day post-operative mortality fell from 23.9% to 7.7% in a cohort of 9,153 surgical patients treated before and after the frailty screening was implemented.  Now the RAI is used at five VAMCs and five hospitals that are part of the University of Pittsburgh Healthcare System.  Interventions that are now benefiting frail patients include palliative care referral before surgery, preoperative strength training, respiratory muscle training, and nutritional optimization. Though the screening takes less than 30 seconds to administer, its results provide patients, surgeons and the clinical care team with reliable data to inform surgical decision-making, optimize preoperative care, and reduce the need for long term services and support following surgery.

180-day post-operative mortality fell from 23.9% to 7.7% in a cohort of 9,153 surgical patients treated before and after the frailty screening was implemented.

Predictably, frail patients suffer disproportionally high rates of adverse postoperative complications, including death. While surgeons currently consider age and comorbity to determine patients' risks, they did not have an easily administered tool to routinely screen for frailty, which is a more accurate predictor of poor outcomes after surgery.  Dr. Hall's innovation provides essential information for real-time decision-making that has already saved lives and shown improved care in both VA and non-VA settings. 

Open links below to read more about the development and validation in the surgical frailty assessment tool:

Annals of Surgery:  Recalibration and External Validation of the Risk Analysis Index March 19, 2019

JAMA Network Open:  Association of Frailty and Postoperative Complications With Unplanned Readmissions After Elective Outpatient Surgery May 3, 2019

JAMA Surgery:  Association of a Frailty Screening Initiative With Postoperative Survival at 30, 180, and 365 Days March 1, 2017






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