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Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study
Author(s) -
ALKhamis A.,
Warner C.,
Park J.,
Marecik S.,
Davis N.,
Mellgren A.,
Nordenstam J.,
Kochar K.
Publication year - 2019
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.14725
Subject(s) - medicine , frailty index , odds ratio , univariate analysis , multivariate analysis , retrospective cohort study , hospital readmission , surgery , emergency medicine
Aim Frailty is defined as a decrease in physiological reserve with increased risk of morbidity following significant physiological stressors. This study examines the predictive power of the five‐item modified frailty index (5‐mFI) in predicting outcomes in colorectal surgery patients. Methods The American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2011 to 2016 to determine the predictive power of 5‐mFI in patients who had colorectal surgery. Results Of 295 490 patients, 45.8% had a score of 0, 36.2% had a score of 1 and 18% had a score of ≥ 2. On univariate analysis, frailer patients had significantly greater incidences for overall morbidity, serious morbidity, mortality, prolonged length of hospital stay, discharge to a facility other than home, reoperation and unplanned readmission. These findings were consistent on multivariate analysis where the frailest patients had greater odds of postoperative overall morbidity (OR 1.39; 95% CI 1.35–1.43), serious morbidity (OR 1.39; 95% CI 1.33–1.45), mortality (OR 2.00; 95% CI 1.87–2.14), prolonged length of hospital stay (OR 1.24; 95% CI 1.20–1.27), discharge destination to a facility other than home (OR 2.80; 95% CI 2.70–2.90), reoperation (OR 1.17; 95% CI 1.11–1.23) and unplanned readmission (OR 1.31; 95% CI 1.26–1.36). Weighted kappa statistics showed strong agreement between the 5‐mFI and 11‐mFI (kappa = 0.987, P < 0.001). Conclusions The 5‐mFI is a valid and easy to use predictor of 30‐day postoperative outcomes after colorectal surgery. This tool may guide the surgeon to proactively recognize frail patients to instigate interventions to optimize them preoperatively.