Evaluating frailty using the modified frailty index for colonic diverticular disease surgery: analysis of the national inpatient sample 2015-2019.

BACKGROUND: Frailty has been associated with increased postoperative mortality and morbidity; however, the use of the modified frailty index (mFI-11) to assess patients undergoing surgery for diverticular disease has not been widely assessed. This paper aims to examine frailty, evaluated by mFI-11, to assess postoperative morbidity and mortality among patients undergoing operative intervention for colonic diverticular disease. METHODS: We used data from the Healthcare Cost and Utilization Project National Inpatient Sample (October 1, 2015-December 31, 2019). ICD-10-CM codes were utilized to identify a cohort of adult patients with a primary admission diagnosis of diverticulitis. mFI-11 items were adapted to correspond with ICD-10-CM codes. Patients were stratified into robust (mFI < 0.27) and frail (mFI ≥ 0.27) groups. Primary outcomes were in-hospital postoperative morbidity and mortality. Secondary outcomes included system-specific postoperative complications, length of stay (LOS), total admission cost, and discharge disposition. Multivariable regression models were fit. RESULTS: Of the 26,826 patients, there were 24,194 patients with mFI-11 < 0.27 (i.e., robust) and 2,632 patients with mFI-11 ≥ 0.27 (i.e., frail). Adjusted analysis showed significant increases in postoperative mortality (aOR 2.16, 95% CI 1.38-3.38, p = 0.001) and overall postoperative morbidity (aOR 1.84, 95% CI 1.65-2.06, p < 0.001). LOS was higher in the frail group (MD 1.78 days, 95% CI 1.46-2.11, p < 0.001) as well as total cost (MD $25,495.19, 95% CI $19,851.63-$31,138.75, p < 0.001). CONCLUSION: In the elective setting, a high mFI-11 (i.e., presence of the variables comprising the index) could alert clinicians to the possibility of implementing preoperative optimization strategies. In the emergent setting, a high mFI-11 may help guide prognostication for these vulnerable patients.

Across demographics and recent history, most parents sing to their infants and toddlers daily.

Music is universally prevalent in human society and is a salient component of the lives of young families. Here, we studied the frequency of singing and playing recorded music in the home using surveys of parents with infants (N = 945). We found that most parents sing to their infant on a daily basis and the frequency of infant-directed singing is unrelated to parents' income or ethnicity. Two reliable individual differences emerged, however: (i) fathers sing less than mothers and (ii) as infants grow older, parents sing less. Moreover, the latter effect of child age was specific to singing and was not reflected in reports of the frequency of playing recorded music. Last, we meta-analysed reports of the frequency of infant-directed singing and found little change in its frequency over the past 30 years, despite substantial changes in the technological environment in the home. These findings, consistent with theories of the psychological functions of music, in general, and infant-directed singing, in particular, demonstrate the everyday nature of music in infancy. This article is part of the theme issue 'Voice modulation: from origin and mechanism to social impact (Part I)'.