Frailty Predicts Morbidity after Colectomy for Ulcerative Colitis

Abstract

The rate of ulcerative colitis (UC), an inflammatory bowel disease, has been on the rise in the United States for the last several decades. Colectomy can be performed when other treatment options cannot provide a reasonable quality of life to patients with UC. Frailty has been shown to be a strong tool for evaluating preoperative risk factors for poor postoperative outcomes. The National Surgical Quality and Improvement Program cross-institutional database was used for this study. Data from 943 patients who underwent colectomy for UC between 2005 and 2012 were evaluated. Modified frailty index (mFI) is a previously described and validated 11-variable frailty measure used in the National Surgical Quality and Improvement Program to assess frailty. Outcome measures included serious morbidity; overall morbidity; cardiopulmonary, septic, and wound complications; and Clavien class IV (requiring ICU) and V (mortality) complications. Median age was 46 years and median body mass index was 25.5 Kg/m2. In all, 54.3 per cent of patients were male and 39.38 per cent of patients were American Society of Anesthesiologists Class lll or higher. The median mFI was 0 (0–0.54). As the mFI increased from 0 (nonfrail) to 0.18 and above, the overall morbidity increased from 25.40 to 52.1 per cent ( P < 0.05), serious morbidity increased from 14.9 to 42.1 per cent ( P < 0.05), septic complications increased from 9.87 to 21.49 per cent ( P < 0.05), cardiopulmonary complications increased from 2.98 to 23.14 per cent ( P < 0.05), Clavien class IV complications increased from 3.5 to 26.5 per cent ( P < 0.05), and Clavien V complications increased from 0.16 to 6.61 per cent ( P < 0.05). On multivariate analysis, mFI was an independent predictor of septic complications [Adjusted Odds Ratio (AOR): 31.26; P = 0.006], cardiopulmonary complications (AOR: 216.3; P ≤ 0.001), serious morbidity(AOR: 66.8; P ≤ 0.001), overall morbidity (AOR: 25.5; P ≤ 0.001), Clavien class IV (AOR: 204.9; P ≤ 0.001) complications, and return to the operating room (AOR: 14.29; P = 0.048). Frailty is associated with an increase in morbidity and mortality after colectomy in patients with UC. mFI is an easy-to-use tool and can play an important role in the risk stratification of these patients.

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“…In the same database, a study applying a frailty index validated in the database to a cohort of 943 patients who underwent a colectomy for UC, found that frailty was an independent and significant predictor of septic and cardiopulmonary complications, serious morbidity, re-operation, and overall mortality. 91 …”