Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program

Obeid, Nadia; Azuh, Ogochukwu; Reddy, Subhash; Webb, Shawn; Reickert, Craig A.; Velanovich, Vic; Horst, H. Mathilda; Rubinfeld, Ilan

doi:10.1097/ta.0b013e31824d0f70

Cited by 189 publications

(117 citation statements)

References 16 publications

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“…Most studies were observational (23 of 35) with a total of 1 153 684 patients available for the analysis. Cohorts were composed of patients undergoing lower gastrointestinal (GI) surgery (10 studies), upper GI surgery (6), mixed GI surgery (4), gynaecological surgery (6), urological surgery (4) and mixed abdominal surgery (6) ( Table 1)1 12, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

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Section: Resultsmentioning

confidence: 99%

“…The prevalence of frail patients ranged from 0·5 to 67·2 per cent. Most surgical procedures were performed for cancer; only four studies25 28, 29 41 had fewer than half of the patients without malignancy.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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“…6,7 Frailty has been utilized to analyze multiple postoperative complications, including mortality. 8,9 However, there is insufficient literature regarding the impact of unplanned reintubation in the elderly population.…”

Section: Introductionmentioning

confidence: 99%

Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis

Karamanos

Schmoekel

Blyden

et al. 2016

TPJ

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Background: Unplanned postoperative reintubation increases the risk of mortality, but associated factors are unclear.Objective: To elucidate factors associated with increased mortality risk in patients with unplanned postoperative reintubation.Design: Retrospective study. Patients older than 40 years who underwent unplanned reintubation from 2005 to 2010 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Multiple regression models were used to examine the impact on mortality of factors that included the modified frailty index (mFI) we developed, American Society of Anesthesiologists (ASA) score, age decile, and days to reintubation.Main Outcome Measure: Mortality.Results: A total of 17,051 postoperative reintubations in adults were analyzed. Overall mortality was 29.4% (n = 5009). On postoperative day 1, 4434 patients were reintubated and 878 (19.8%) died. On postoperative day 7 and beyond, 6329 patients were reintubated and 2215 (35.0%) died. Increasing mFI resulted in increasing incidence of mortality (mFl of 0 = 20.5% mortality vs mFl of 0.37-0.45 = 41.7% mortality). As ASA score increased from 1 to 5, reintubation was associated with a mortality of 12.1% to 41.6%, respectively. Similarly, increasing age decile was associated with increasing incidence of mortality (40-49 years, 17.9% vs 80-89 years, 42.1%). After adjustment for confounding factors, mFI, ASA score, age decile, and increasing number of days to reintubation were independently and significantly associated with increased mortality in the study population.Conclusion: Among patients who underwent unplanned reintubation, older and more frail patients had an increased risk of mortality.

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“…This effect was more pronounced when the relative surgical risk was low, the converse of which the researchers confirmed in a second study of patients undergoing very complex surgery, in whom complications and mortality were less well correlated with frailty [56]. Perhaps of greater clinical relevance, when the researchers analysed data from 58 000 patients undergoing open and laparo-scopic colectomy, they found that the proportion of patients experiencing complications requiring intensive care admission correlated with increases in the same modified 11-point Frailty Index [57]; laparoscopic colectomy was associated with lower complication rates among frail patients.…”

Section: Peri-operative Implicationsmentioning

confidence: 48%

Patient frailty: the elephant in the operating room

2013

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SummaryFor most surgeons and many anaesthetists, patient frailty is currently the 'elephant in the (operating) room': it is easy to spot, but is often ignored. In this paper, we discuss different approaches to the measurement of frailty and review the evidence regarding the effect of frailty on peri-operative outcomes. We explore the limitations of 'eyeballing' patients to quantify frailty, and consider why the frail older patient, challenged by seemingly minor insults in the postoperative period, may suffer falls or delirium. Frailty represents a state of increased vulnerability to stressors, and older inpatients are exposed to multiple stressors in the peri-operative setting. Quantifying frailty is likely to increase the precision of peri-operative risk assessment. The Frailty Index derived from Comprehensive Geriatric Assessment is a simple and robust way to quantify frailty, but is yet to be systematically investigated in the preoperative setting. Furthermore, the optimal care for frail patients and the reversibility of frailty with prehabilitation are fertile areas for future research. (While I can't define it)…I know it when I see it.-Justice Potter Stewart, US Supreme Court Clinicians usually recognise a frail patient, who is often, but not always, elderly. However, at best, we usually quantify frailty in a largely subjective 'end-of-the-bed' or 'eyeball' way [1]. Furthermore, although studies have examined patient factors such as age and ASA physical status and their association with peri-operative complications and mortality [2-4], until very recently, few have examined frailty [5]. Frailty increases vulnerability to stressors, which, in the peri-operative setting, can include the procedure(s), complications and medical care administered.The aims of this paper are to review the emerging science around defining and quantifying frailty, and to examine its associated peri-operative risks. Current evidence suggests that quantifying frailty improves the precision of risk assessment [5]. However, we think that, for most surgeons and many anaesthetists, frailty and its associated risks represent an 'elephant in the (operating) room': it is easy to spot, but is often ignored.

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Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program

Abstract: Complications requiring ICU care represent a significant morbidity in the colectomy patient population. Frailty index seems to be an important predictor of ICU-level complications and death, and laparoscopy seems to be protective.

Cited by 189 publications

References 16 publications

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Association of Unplanned Reintubation with Higher Mortality in Old, Frail Patients: A National Surgical Quality-Improvement Program Analysis

Patient frailty: the elephant in the operating room

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