Results From October 1, 2007, to July 1, 2014, a total of 9153 patients underwent surgery (mean [SD] age,  years; female, 653 [%]; and white, 7096 [%]). Overall 30-day mortality decreased from % (84 of 5275 patients) to % (26 of 3878 patients, P < .001) after FSI implementation. Improvement was greatest among frail patients (% [24 of 197 patients] to % [16 of 424 patients], P < .001), although mortality rates also decreased among the robust patients (% [60 of 5078 patients] to % [10 of 3454 patients], P < .001). The magnitude of improvement among frail patients increased at 180 (% [47 of 197 patients] to % [30 of 389 patients], P < .001) and 365 days (% [68 of 197 patients] to % [36 of 309 patients], P < .001). Multivariable models revealed improved survival after FSI implementation, controlling for age, frailty, and predicted mortality (adjusted odds ratio for 180-day survival, ; 95% CI, -).
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