Date of Award

January 2020

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Shamsuddin Akhtar

Second Advisor

Paul Heerdt


Frailty is defined by the World Health Organization as a “progressive age-related decline in physiological systems…which confers extreme vulnerability to stressors and increases the risk of a range of adverse health outcomes.” Frailty has been associated with an increased risk of perioperative morbidity and mortality, longer hospital length of stay, and discharge to a facility, instead of home. More than 40 different frailty measures with varying predictive ability have been created; however, an electronic medical record (EMR)-derived frailty metric provides a useful option that could quickly estimate frailty to determine additional associated perioperative risks. The purpose of this study was to conduct a pilot retrospective cohort study in a homogenous population of women undergoing elective gynecological surgery to establish the relationship between an EMR-derived frailty metric described by Amrock et al. 2014 and hypotension following induction of general anesthesia. For the study, post-induction hypotension (PIH) was defined as a mean arterial pressure (MAP) <55mmHg, MAP change >20%, or vasopressor use within 10 min of induction using both bivariate and multivariate models. Although 74.3% of patients experienced PIH, our data demonstrated that the Amrock EMR-derived model was not associated with PIH. However, a new frailty measure constructed from components of this model was associated with vasopressor use. Furthermore, lower pre-induction MAP was associated with increased MAP <55mmHg and decreased MAP change >20% by both univariate and multivariate models. Overall, our study indicates that either additional patients or another frailty metric should be used to better investigate the impact of frailty upon PIH and subsequent vasopressor use in elderly female patients undergoing elective gynecological surgery.


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