Shipra Arya GEMSSTAR Grant and PDP Takes Closer Look at Frail Patients

August 2016

Emory vascular surgeon Shipra Arya, MD, has been studying the intersection of aging, vascular disease, and surgical quality for several years. She has investigated the effectiveness of vascular surgical interventions in the elderly; developed prediction models for peripheral arterial disease (PAD), a condition that primarily affects people over 50; and worked to design a reliable algorithm for identifying PAD patients of the Atlanta VA Medical Center. Her movement into this field of study was advanced further in August when she received funding from the National institute of Aging's Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR).

The grant includes a supplemental Professional Development Plan (PDP), funded by a Jahnigen Career Development Award. The PDP will support additional learning activities designed to complement Arya's GEMSSTAR project. Jahnigen Awards are coordinated by the American Geriatric Society and, in Arya's case, funded by the Society for Vascular Surgery Foundation.

The GEMSSTAR Program provides support for early stage clinician-scientists to establish a track record in aging research, and primarily backs projects that are preparing for managing the medical needs of a rising population of older Americans with complex medical problems. Arya's GEMSTARR study, "Failure to rescue in frail surgical patients," is concerned with frailty and the increase of its potential effect on surgical outcomes as the population ages.

Frailty is typically identified in older patients, and is characterized by decline and weakness in physical function, and increased vulnerability and poor recovery in reaction to such stressors as illness and surgery. Recent data demonstrate that frailty is a powerful predictor of increased perioperative mortality, morbidity, and cost in various surgical populations.

"Although frailty is distinct from age, it is highly correlated," says Arya. "The growing prevalence of older patients with frailty will place greater demands on surgical services. To provide the best quality of care, it is imperative that healthcare providers and hospitals develop strategies to meet these growing demands, and to ensure higher-quality care for geriatric surgical patients."

Arya's study will be the first to examine if frailty impacts failure to rescue (FTR) independent of other hospital factors. FTR is being unable to prevent death from treatable complications during hospitalization (e.g. major hemorrhage after surgery), and is used as a metric for hospital quality. The study will also seek to determine whether certain hospitals are more successful at treating frail patients, and what characteristics these hospitals might share.

Arya hopes the study's findings will change the way FTR is calculated for hospital quality and influence the development of new interventions and protocols for improving surgical outcomes in frail patients.

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