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 E. Efron

Research output: Contribution to journalArticlepeer-review

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)640-649
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume22
Issue number4
DOIs
StatePublished - Apr 1 2018

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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