Association of frailty with outcomes after elective colon resection for diverticular disease

Lee, Cory; Mabeza, Russyan Mark; Verma, Arjun; Tran, Zachary; Hadaya, Joseph; Lee, Hanjoo; Benharash, Peyman

doi:10.1016/j.surg.2022.03.025

Cited by 5 publications

(8 citation statements)

References 47 publications

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“…In a large-scale retrospective analysis on the impact of frailty following colectomy, Hadaya et al concluded frailty is associated with mortality, increased healthcare cost, higher rate of re-admission and longer HLOS [ 32 ]. Frailty has also been shown to be associated with a 59% relative increased risk of postoperative ileus following colonic resection [ 33 ]. In a similar analysis, Venkat et al determined the modified frailty index independently predicts morbidity, mortality, cardiopulmonary complications and prolonged HLOS in patients with clostridium difficile [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors

Elgar

Smiley²,

Smiley

et al. 2022

IJERPH

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Background: In the United States, ileus accounts for USD 750 million of healthcare expenditures annually and significantly contributes to morbidity and mortality. Despite its significance, the complete picture of mortality risk factors for these patients have yet to be fully elucidated; therefore, the aim of this study is to identify mortality risk factors in patients emergently admitted with paralytic ileus. Methods: Adult and elderly patients emergently admitted with paralytic ileus between 2005–2014 were investigated using the National Inpatient Sample Database. Clinical outcomes, therapeutic management, demographics and comorbidities were collected. Associations between mortality and all other variables were established via univariable and multivariable logistic regression models. Results: A total of 81,674 patients were included, of which 45.2% were adults, 54.8% elderly patients, 45.8% male and 54.2% female. The average adult and elderly ages were 48.3 and 78.8 years, respectively. Elderly patients displayed a significantly (p < 0.01) higher mortality rate (3.0%) than adults (0.7%). The final multivariable logistic regression model showed that for every one-day delay in operation, the odds of mortality for adult and elderly patients increased by 4.1% (p = 0.002) and 3.2% (p = 0.014), respectively. Every additional year of age corresponded to 3.8% and 2.6% increases in mortality for operatively managed adult (p = 0.026) and elderly (p = 0.015) patients. Similarly, non-operatively treated adult and elderly patients displayed associations between mortality and advanced age (p = 0.001). The modified frailty index exhibited associations with mortality in operatively treated adults, conservatively managed adults and conservatively managed elderly patients (p = 0.001). Every additional day of hospitalization increased the odds of mortality in non-operative adult and elderly patients by 7.6% and 5.8%, respectively. Female sex correlated to lower mortality rates in non-operatively managed adult patients (odds ratio = 0.71, p = 0.028). Undergoing invasive diagnostic procedures in non-operatively managed elderly patients related to reduced mortality (odds ratio = 0.78, p = 0.026). Conclusions: Patients emergently admitted for paralytic ileus with increased hospital length of stay, longer time to operation, advanced age or higher modified frailty index displayed higher mortality rates. Female sex and invasive diagnostic procedures were negatively correlated with death in nonoperatively managed patients with paralytic ileus.

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Section: Discussionmentioning

confidence: 99%

Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors

Elgar

Smiley²,

Smiley

et al. 2022

IJERPH

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“…A large body of literature has demonstrated frailty to consistently portend inferior postoperative outcomes in both emergent and elective settings, irrespective of the assessment method [5][6][7][8][9][10]. However, detailed frailty assessment tests such as gait speed and grip strength may be impractical in the emergent settings.…”

Section: Discussionmentioning

confidence: 99%

“…The Van Walraven modification of the Elixhauser Comorbidity Index, a validated composite of 30 comorbidities, was utilized to quantify the burden of chronic conditions [21]. Individual comorbidities and complications, such as perioperative hemorrhage, postoperative infections, and acute venous thromboembolism (VTE) were tabulated using previously published ICD-9/10 codes [8,[22][23][24]. The diagnosis of VTE was ascertained using codes for acute pulmonary embolism and deep venous thrombosis [23].…”

Section: Variable Definitions and Study Outcomesmentioning

confidence: 99%

“…Traditional risk factors aside, a large body of literature has demonstrated frailty to be a strong, independent marker for increased mortality and perioperative complications [5][6][7][8][9][10]. Frailty is a multifaceted clinical syndrome characterized as a state of physical and cognitive decline, increased vulnerability to stressors and social withdrawal [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…The Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator has been introduced to address these limitations. As a coding-based instrument, the ACG-frailty indicator can be readily used in the clinical setting and has been validated in a multitude of surgical specialties [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Association of frailty with outcomes of resection for colonic volvulus: A national analysis

Ebrahimian¹,

Lee²,

Tran

et al. 2022

PLoS ONE

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Background With limited national studies available, we characterized the association of frailty with outcomes of surgical resection for colonic volvulus. Methods Adults with sigmoid or cecal volvulus undergoing non-elective colectomy were identified in the 2010–2019 Nationwide Readmissions Database. Frailty was identified using the Johns Hopkins indicator which utilizes administrative codes. Multivariable models were developed to examine the association of frailty with in-hospital mortality, perioperative complications, stoma use, length of stay, hospitalization costs, non-home discharge, and 30-day non-elective readmissions. Results An estimated 66,767 patients underwent resection for colonic volvulus (Sigmoid: 39.6%; Cecal: 60.4%). Using the Johns Hopkins indicator, 30.3% of patients with sigmoid volvulus and 15.9% of those with cecal volvulus were considered frail. After adjustment, frail patients had higher risk of mortality compared to non-frail in both sigmoid (10.6% [95% CI 9.47–11.7] vs 5.7% [95% CI 5.2–6.2]) and cecal (10.4% [95% CI 9.2–11.6] vs 3.5% [95% CI 3.2–3.8]) volvulus cohorts. Frailty was associated with greater odds of acute venous thromboembolism occurrences (Sigmoid: AOR 1.50 [95% CI 1.18–1.94]; Cecal: AOR 2.0 [95% CI 1.50–2.72]), colostomy formation (Sigmoid: AOR 1.73 [95% CI 1.57–1.91]; Cecal: AOR 1.48 [95% CI 1.10–2.00]), non-home discharge (Sigmoid: AOR 1.97 [95% CI 1.77–2.20]; Cecal: AOR 2.56 [95% CI 2.27–2.89]), and 30-day readmission (Sigmoid: AOR 1.15 [95% CI 1.01–1.30]; Cecal: AOR 1.26 [95% CI 1.10–1.45]). Frailty was associated with incremental increase in length of stay (Sigmoid: +3.4 days [95% CI 2.8–3.9]; Cecal: +3.8 days [95% CI 3.3–4.4]) and costs (Sigmoid: +$7.5k [95% CI 5.9–9.1]; Cecal: +$12.1k [95% CI 10.1–14.1]). Conclusion Frailty, measured using a simplified administrative tool, is associated with significantly worse clinical and financial outcomes following non-elective resections for colonic volvulus. Standard assessment of frailty may aid risk-stratification, better inform shared-decision making, and guide healthcare teams in targeted resource allocation in this vulnerable patient population.

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Utility of the modified 5-item frailty index as a predictor of postoperative febrile urinary tract infection in patients who underwent ureteroscopy with laser lithotripsy

Tasaka,

Kohada,

Ikeda

et al. 2024

World J Urol

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Purpose This study aimed to assess the effect of the modified 5-item frailty index on perioperative complications and surgical outcomes in patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones. Methods Patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones between 2019 and 2022 were reviewed retrospectively. Assessment was performed using the modified 5-item frailty index based on medical history (hypertension, diabetes, heart failure, chronic obstructive pulmonary disease) and functional status. Patients were categorized into the high (≥ 2) and low (≤ 1) modified 5-item frailty index groups based on the frailty score. We compared the perioperative complications and surgical outcomes between the two groups. Results Seventy-one (15.8%) and 393 (84.1%) of the 467 patients were classified into the high and low modified 5-item frailty index groups, respectively. The high modified 5-item frailty index group exhibited a significant association with increased febrile urinary tract infections compared to the low modified 5-item frailty index group [≥ 37.8 °C: 15 (20.3%) vs 13 (3.3%), p < 0.001; ≥ 38 °C: 9 (12.2%) vs 7 (1.8%), p < 0.001]. Surgical outcomes, including operative time and stone-free rate, did not differ significantly between the two groups. Conclusion The modified 5-item frailty index is valuable for predicting postoperative complications, particularly febrile urinary tract infections, after ureteroscopy with laser lithotripsy for upper urinary tract stones. This index allows for practical preoperative risk assessment in patients who underwent ureteroscopy with laser lithotripsy.

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Association of frailty with outcomes after elective colon resection for diverticular disease

Cited by 5 publications

References 47 publications

Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors

Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors

Association of frailty with outcomes of resection for colonic volvulus: A national analysis

Utility of the modified 5-item frailty index as a predictor of postoperative febrile urinary tract infection in patients who underwent ureteroscopy with laser lithotripsy

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