Preoperative functional health status may predict outcomes after elective colorectal surgery for malignancy

Işık, Özgen; Okkabaz, Nuri; Hammel, Jeffrey; Remzi, Feza H.; Görgün, Emre

doi:10.1007/s00464-014-3777-2

Cited by 10 publications

(11 citation statements)

References 13 publications

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“…We also found that functional status prior to surgery was frequently correlated with cardiac and respiratory complications, and mortality. This is in line with previous studies that have identified preoperative functional health status as an important predictor of outcomes after colorectal surgery, 24 ventral hernia repair, 25 hepatic resections, 26 and infrainguinal bypass surgery. 27 It is also congruent with Scarborough et al's research that studied 30-day postoperative outcomes and found that functionally dependent patients experienced a 75% greater odds of mortality and 51% greater odds of major morbidity than functionally independent patients.…”

Section: Discussionsupporting

confidence: 92%

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The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population

Akyar

Armenia

Ratnani

et al. 2018

Surg J

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Background The burden of frail patients undergoing emergency general surgery (EGS) is increasing rapidly and this population is particularly susceptible to postoperative cardiopulmonary complications and mortality. We aimed to determine the association between frailty, as defined by the previously described modified frailty index (mFI), and postoperative respiratory complications (unplanned reintubation, pneumonia, and prolonged ventilation), cardiac complications (myocardial infarction and cardiac arrest), and mortality. We also sought to identify the most significant determinants of frailty in the highest risk patients based on the specific variables comprising the mFI. Methods We performed a retrospective observational analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database. Files from 2005 to 2015 identified 132,765 inpatients who underwent EGS. mFI scores were calculated for each patient. The effect of increasing frailty on unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality was evaluated using bivariate analysis. Multivariable logistic regression was used to compare mFI with additional predictor variables including race, gender, physical status as defined by the American Society of Anesthesiologists, disseminated cancer, renal failure, smoking status, sepsis, wound presence/classification, dyspnea, and previous ventilator dependence. Results Unplanned reintubation, pneumonia, prolonged ventilation, myocardial infarction, cardiac arrest, and mortality were significantly associated with frailty, and the odds of each postoperative complication increased with increasing mFI score. Of the frailest patients (mFI ≥3) that experienced cardiopulmonary complications or mortality, the variables of the mFI that contributed most to frailty were hypertension requiring medication and functional status before surgery. Conclusions A higher mFI score is associated with increased odds of postoperative cardiopulmonary complications and mortality in the EGS population. Specific variables of the mFI can also provide valuable information for assessing odds in the frailest patients undergoing EGS.

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Section: Discussionsupporting

confidence: 92%

“…These findings correspond with previous research illustrating that among patients who underwent unplanned reintubation, older and more frail patients (as assessed by the mFI) had an increased risk of mortality. 24 …”

Section: Discussionmentioning

confidence: 99%

The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population

Akyar

Armenia

Ratnani

et al. 2018

Surg J

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“…Our finding that preoperative functional impairment is associated with postoperative complications is consistent with findings from small, prospective single-center studies, underscoring the need to implement system-wide efforts. 3,5,11,[36][37][38][39] A larger single-center study assessed 4 BADLs (no IADL) preoperatively, but outcomes were limited to those found in the NSQIP (ie, they did not include geriatric outcomes). 17 We validated an abbreviated 5-item functional status scale proposed by the ACS, NSQIP, and American Geriatrics Society.…”

Section: Discussionmentioning

confidence: 99%

Estimating Risk of Postsurgical General and Geriatric Complications Using the VESPA Preoperative Tool

et al. 2017

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“…Functional status is emerging as a predictor for poor outcomes in a number of surgical populations (22, 23). In cancer patients, functional status is used to determine fitness for chemotherapy (24). The Eastern Cooperative Oncology Group functional status assessment tool (25) is routinely used to determine fitness for chemotherapy, and can be helpful in determining fitness to withstand surgery as well.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after emergency abdominal surgery in patients with advanced cancer

Cauley

Panizales

Reznor

et al. 2015

Journal of Trauma and Acute Care Surgery

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Background There is increasing emphasis on the appropriateness and quality of acute surgical care for patients with serious illness, and at the end-of-life. However, there is a lack of evidence regarding outcomes after emergent major abdominal surgery among patients with advanced cancer to guide treatment decisions. This analysis seeks to characterize adverse outcomes (mortality, complications, institutional discharge) and to identify factors independently associated with 30-day mortality among patients with disseminated cancer who undergo emergent abdominal surgery for intestinal obstruction or perforation. Methods This is a retrospective cohort study of 875 disseminated cancer patients undergoing emergency surgery for perforation (n=499) or obstruction (n=376) at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2005-2012. Predictors of 30 day mortality were identified using multivariate logistic regression. Results Among patients who underwent surgery for perforation, 30-day mortality was 34%, 67% had complications and 52% were discharged to an institution. Renal failure, septic shock, ascites, dyspnea at rest, and dependent functional status were independent preoperative predictors of death at 30 days. When complications were considered, postoperative respiratory complications and age (75-84 years) were also predictors of mortality. Patients who had surgery for obstruction had a 30-day mortality rate of 18% (n=68), 41% had complications, and 60% were discharged to an institution. Dependent functional status and ascites were independent predictors of death at 30 days. In addition to these predictors, postoperative predictors of mortality included respiratory and cardiac complications. Few patients (4%) had DNR orders prior to surgery. Conclusions Emergency abdominal operations in patients with disseminated cancer are highly morbid and many patients die soon after surgery. High rates of complications, and low rates of pre-existing DNR orders highlight the need for targeted interventions to reduce complications and integrate palliative approaches into the care of these patients. Level of Evidence III Study Type Prognostic

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Preoperative functional health status may predict outcomes after elective colorectal surgery for malignancy

Cited by 10 publications

References 13 publications

The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population

The Impact of Frailty on Postoperative Cardiopulmonary Complications in the Emergency General Surgery Population

Estimating Risk of Postsurgical General and Geriatric Complications Using the VESPA Preoperative Tool

Outcomes after emergency abdominal surgery in patients with advanced cancer

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