TY - JOUR
T1 - Frailty is a better predictor than age for outcomes in geriatric patients with rectal cancer undergoing proctectomy
AU - Miller, Samuel M.
AU - Wolf, J.
AU - Katlic, M.
AU - D'Adamo, C. R.
AU - Coleman, J.
AU - Ahuja, V.
N1 - Funding Information:
Drs Katlic and Coleman are core members of the American College of Surgeons Coalition for Quality in Geriatric Surgery and are supported by a grant from the John A. Hartford Foundation. This work was not part of the grant.
Publisher Copyright:
© 2020 Elsevier Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/9
Y1 - 2020/9
N2 - Background: Both frailty and older age are risk factors for adverse surgical outcomes. We hypothesized that frailty, regardless of patient age, is a predictor of poor postoperative outcome among patients with rectal cancer undergoing proctectomy. Methods: Patients with primary rectal cancer undergoing proctectomy between 2012 to 2015 were identified in the database of the National Quality Improvement Program. The simplified, 5-item frailty index was grouped into 0, 1, 2, and ≥3. Outcomes were morbidity and 30-day mortality. Results: This study involved 9,252 patients from the National Quality Improvement Program database. Increasingly frail patients had greater morbidity and mortality (P < .001). Logistic regression revealed that frailty was a predictor of morbidity (odds ratio = 6.7, P < .0001); in contrast, older age was not associated with morbidity when adjusting for frailty (odds ratio = 1.2, P = .14). Both older age and frailty were associated with greater mortality, with frailty (odds ratio = 20.8, P < .0001) more so than older age (odds ratio = 10.3, P < .0001). Conclusion: Frailty was more strongly associated with morbidity and mortality than older age in patients undergoing proctectomy. Surgical options can be expanded to older patients with the use of simplified, 5-item frailty index as a decision-making tool.
AB - Background: Both frailty and older age are risk factors for adverse surgical outcomes. We hypothesized that frailty, regardless of patient age, is a predictor of poor postoperative outcome among patients with rectal cancer undergoing proctectomy. Methods: Patients with primary rectal cancer undergoing proctectomy between 2012 to 2015 were identified in the database of the National Quality Improvement Program. The simplified, 5-item frailty index was grouped into 0, 1, 2, and ≥3. Outcomes were morbidity and 30-day mortality. Results: This study involved 9,252 patients from the National Quality Improvement Program database. Increasingly frail patients had greater morbidity and mortality (P < .001). Logistic regression revealed that frailty was a predictor of morbidity (odds ratio = 6.7, P < .0001); in contrast, older age was not associated with morbidity when adjusting for frailty (odds ratio = 1.2, P = .14). Both older age and frailty were associated with greater mortality, with frailty (odds ratio = 20.8, P < .0001) more so than older age (odds ratio = 10.3, P < .0001). Conclusion: Frailty was more strongly associated with morbidity and mortality than older age in patients undergoing proctectomy. Surgical options can be expanded to older patients with the use of simplified, 5-item frailty index as a decision-making tool.
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U2 - 10.1016/j.surg.2020.05.027
DO - 10.1016/j.surg.2020.05.027
M3 - Article
C2 - 32665144
AN - SCOPUS:85087803315
SN - 0039-6060
VL - 168
SP - 504
EP - 508
JO - Surgery (United States)
JF - Surgery (United States)
IS - 3
ER -