Impact of Frailty on Patient Outcomes after Hartmann’s Reversal: A NSQIP Analysis

Abstract

Background Colostomy reversal is a common procedure. Patients often have baseline comorbidities associated with postoperative morbidity. We utilized a modified frailty index (mFI-5) to predict postoperative complications. Methods Patients who underwent elective, open Hartmann’s reversal were queried from the National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified to low, medium, or high frailty groups. Statistical analysis was performed using chi-squared, ANOVA, and logistic regression. Results There were 9272 patients with Hartmann’s reversal. 48.78%, 30.31%, and 12.89% had low, moderate, or high frailty, respectively. High frailty was associated with cardiac arrest, myocardial infarction, reintubation, prolonged intubation, early reoperation, and mortality. After multivariate analysis, high frailty was associated with prolonged intubation (OR 3.147, P = .001), reintubation (OR 2.548, P = .002), and reoperation (OR 1.67, P < .001). Conclusions Frailty was associated with greater risk of postoperative complications in patients undergoing Hartmann’s reversal. Frailty may be a useful adjunct to stratify for patients who are at risk for postoperative complications.

Association of Frailty With Post-Operative Outcomes of Older Adults Undergoing Elective Ostomy Reversal

“…A recent NSQIP analysis by Kooragayala et al found frailty (also defined by the 5-item MFI) predicted worse outcomes among patients undergoing Hartmann’s reversal. 24 Interestingly, frailty was not a predictor of mortality in our elective surgery study population, and it appears that in prior literature, studies including non-elective surgery found mortality differences by frailty score. This finding likely reflects selection bias in the current cohort of patients who were selected to undergo elective ostomy reversal and likely felt to have a low risk of perioperative mortality.…”

“…Our findings are consistent with prior studies showing the negative impact of frailty on post-operative outcomes. 7–12,24 Two recent systematic reviews have supported the finding that frailty is associated with worse outcomes in colorectal surgery. Maturana et al reviewed 17 studies and concluded that frail patients undergoing elective or emergent colorectal cancer surgery have more post-operative complications, and in 5 of 7 included studies found higher mortality rates among frail patients.…”

“…22,23 Few prior studies have specifically evaluated the role of frailty in predicting outcomes of ostomy closure in older adults. 24 Therefore, the aim of this study is to assess the impact of frailty on post-operative outcomes of older adults undergoing elective ostomy reversal. Specifically, the study identifies the impact of frailty, as measured by the 5item MFI, on the perioperative outcomes of 30-day mortality, 30-day serious complications, discharge to skilled nursing facility, and 30-day readmission.…”

“…22,23 Few prior studies have specifically evaluated the role of frailty in predicting outcomes of ostomy closure in older adults. 24…”