The Effect of Frailty Index on Early Outcomes after Combined Colorectal and Liver Resections

Sophia Y. Chen, Miloslawa Stem, Marcelo Cerullo, Susan L Gearhart, Bashar Safar, Sandy H Fang, Matthew J Weiss, Jin He, Jonathan Efron

Research output: Contribution to journalArticle

Abstract

Background: Although previous studies have examined frailty as a potential predictor of adverse surgical outcomes, little is reported on its application. We sought to assess the impact of the 5-item modified frailty index (mFI) on morbidity in patients undergoing combined colorectal and liver resections. Methods: Adult patients who underwent combined colorectal and liver resections were identified using the ACS-NSQIP database (2005–2015). The 5-item mFI consists of history of chronic obstructive pulmonary disease, congestive heart failure, hypertension, diabetes, and partial/total dependence. Patients were stratified into three groups: mFI 0, 1, or ≥ 2. The impact of the mFI on primary outcomes (30-day overall and serious morbidity) was assessed using multivariable logistic regression. Subgroup analyses by age and hepatectomy type was also performed. Results: A total of 1928 patients were identified: 55.1% with mFI = 0, 33.2% with mFI = 1, and 11.7% with mFI ≥ 2. 75.9% of patients underwent wedge resection/segmentectomy (84.6% colon, 15.4% rectum), and 24.1% underwent hemihepatectomy (88.8% colon, 11.2% rectum). On unadjusted analysis, patients with mFI ≥ 2 had significantly greater rates of overall and serious morbidity, regardless of age and hepatectomy type. These findings were consistent with the multivariable analysis, where patients with mFI ≥ 2 had increased odds of overall morbidity (OR 1.41, 95% CI 1.02–1.96, p = 0.037) and were more than twice likely to experience serious morbidity (OR 2.12, 95% CI 1.47–3.04, p < 0.001). Conclusions: The 5-item mFI is significantly associated with 30-day morbidity in patients undergoing combined colorectal and liver resections. It is a tool that can guide surgeons preoperatively in assessing morbidity risk in patients undergoing concomitant resections.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Dec 5 2017

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Liver
Morbidity
Hepatectomy
Rectum
Colon
Segmental Mastectomy
Chronic Obstructive Pulmonary Disease
Heart Failure
Logistic Models
Databases
Hypertension

Keywords

  • Frailty index
  • Morbidity
  • Mortality
  • Synchronous colorectal liver metastasis

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

The Effect of Frailty Index on Early Outcomes after Combined Colorectal and Liver Resections. / Chen, Sophia Y.; Stem, Miloslawa; Cerullo, Marcelo; Gearhart, Susan L; Safar, Bashar; Fang, Sandy H; Weiss, Matthew J; He, Jin; Efron, Jonathan.

In: Journal of Gastrointestinal Surgery, 05.12.2017, p. 1-10.

Research output: Contribution to journalArticle

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abstract = "Background: Although previous studies have examined frailty as a potential predictor of adverse surgical outcomes, little is reported on its application. We sought to assess the impact of the 5-item modified frailty index (mFI) on morbidity in patients undergoing combined colorectal and liver resections. Methods: Adult patients who underwent combined colorectal and liver resections were identified using the ACS-NSQIP database (2005–2015). The 5-item mFI consists of history of chronic obstructive pulmonary disease, congestive heart failure, hypertension, diabetes, and partial/total dependence. Patients were stratified into three groups: mFI 0, 1, or ≥ 2. The impact of the mFI on primary outcomes (30-day overall and serious morbidity) was assessed using multivariable logistic regression. Subgroup analyses by age and hepatectomy type was also performed. Results: A total of 1928 patients were identified: 55.1{\%} with mFI = 0, 33.2{\%} with mFI = 1, and 11.7{\%} with mFI ≥ 2. 75.9{\%} of patients underwent wedge resection/segmentectomy (84.6{\%} colon, 15.4{\%} rectum), and 24.1{\%} underwent hemihepatectomy (88.8{\%} colon, 11.2{\%} rectum). On unadjusted analysis, patients with mFI ≥ 2 had significantly greater rates of overall and serious morbidity, regardless of age and hepatectomy type. These findings were consistent with the multivariable analysis, where patients with mFI ≥ 2 had increased odds of overall morbidity (OR 1.41, 95{\%} CI 1.02–1.96, p = 0.037) and were more than twice likely to experience serious morbidity (OR 2.12, 95{\%} CI 1.47–3.04, p < 0.001). Conclusions: The 5-item mFI is significantly associated with 30-day morbidity in patients undergoing combined colorectal and liver resections. It is a tool that can guide surgeons preoperatively in assessing morbidity risk in patients undergoing concomitant resections.",
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AU - Gearhart, Susan L

AU - Safar, Bashar

AU - Fang, Sandy H

AU - Weiss, Matthew J

AU - He, Jin

AU - Efron, Jonathan

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