The Effect of Frailty Index on Early Outcomes after Combined Colorectal and Liver Resections

Chen, Sophia Y.; Stem, Miloslawa; Cerullo, Marcelo; Gearhart, Susan L.; Safar, Bashar; Fang, Sandy H.; Weiss, Matthew J.; He, Jin; Efron, Jonathan E.

doi:10.1007/s11605-017-3641-5

Cited by 47 publications

(45 citation statements)

References 29 publications

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“…We also found that patients with higher frailty scores were more likely to have open surgery. This is despite multiple studies reporting that higher morbidity is associated with the open compared to the minimally invasive approach [25,[27][28][29] and that the laparoscopic approach is protective against intensive care unit level complications in colectomy patients [10]. Known attributes of laparoscopic surgery, such as smaller incisions, less intra-operative blood loss, shorter LOS and faster recovery might dilute the magnitude of the physiological stress associated with a colectomy [25,[27][28][29].…”

Section: Discussionmentioning

confidence: 99%

“…Chen et al . examined the impact of 5‐mFI scores on 1928 patients who had combined liver and colon resections and reported mFI ≥ 2 to be significantly associated with increased odds of overall and serious morbidity. Vermillion et al .…”

Section: Discussionmentioning

confidence: 99%

“…Our results are consistent with previous published work. Chen et al [25] examined the impact of 5-mFI scores on 1928 patients who had combined liver and colon resections and reported mFI ≥ 2 to be significantly associated with increased odds of overall and serious morbidity. Vermillion et al [18] reported 11-mFI to be an independent predictor of major complications, prolonged LOS and mortality in surgical oncology patients.…”

Section: Discussionmentioning

confidence: 99%

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Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study

et al. 2019

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Aim Frailty is defined as a decrease in physiological reserve with increased risk of morbidity following significant physiological stressors. This study examines the predictive power of the five‐item modified frailty index (5‐mFI) in predicting outcomes in colorectal surgery patients. Methods The American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2011 to 2016 to determine the predictive power of 5‐mFI in patients who had colorectal surgery. Results Of 295 490 patients, 45.8% had a score of 0, 36.2% had a score of 1 and 18% had a score of ≥ 2. On univariate analysis, frailer patients had significantly greater incidences for overall morbidity, serious morbidity, mortality, prolonged length of hospital stay, discharge to a facility other than home, reoperation and unplanned readmission. These findings were consistent on multivariate analysis where the frailest patients had greater odds of postoperative overall morbidity (OR 1.39; 95% CI 1.35–1.43), serious morbidity (OR 1.39; 95% CI 1.33–1.45), mortality (OR 2.00; 95% CI 1.87–2.14), prolonged length of hospital stay (OR 1.24; 95% CI 1.20–1.27), discharge destination to a facility other than home (OR 2.80; 95% CI 2.70–2.90), reoperation (OR 1.17; 95% CI 1.11–1.23) and unplanned readmission (OR 1.31; 95% CI 1.26–1.36). Weighted kappa statistics showed strong agreement between the 5‐mFI and 11‐mFI (kappa = 0.987, P < 0.001). Conclusions The 5‐mFI is a valid and easy to use predictor of 30‐day postoperative outcomes after colorectal surgery. This tool may guide the surgeon to proactively recognize frail patients to instigate interventions to optimize them preoperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study

et al. 2019

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“…Higher rFI scores were significantly associated with postoperative complications, prolonged LOS, and mortality, while higher mFI scores were linked only to a higher risk of morbidity but neither mortality nor LOS [49] . Chen et al [69] evaluated the use of a five-item mFI to assess the effect of frailty on outcomes in patients undergoing combined colorectal and liver resection for colorectal cancer and liver metastases. Patients with higher mFI scores exhibited a higher incidence of mortality, overall and severe morbidity, as well as prolonged LOS.…”

Section: Liver Resection and Frailtymentioning

confidence: 99%

Frailty and Liver resection: where do we stand?

Sioutas¹,

Ziogas²,

Tsoulfas³

2020

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As the world population is continuously aging, the number of older patients requiring liver surgery is also on the rise. Data have shown that age should not be a limiting factor for liver resection, as it cannot accurately predict postoperative outcomes. Instead, frailty can serve as a more reliable measure of the patient's overall health and functional reserves. Several frailty assessment tools have been implemented for preoperative risk stratification before liver surgery, and higher scores have commonly been associated with postoperative morbidity, mortality, and length of hospital stay. However, no consensus has been reached on the most useful screening tool. Future studies should focus on comparing the currently available assessment tools, constructing a liver resection-specific tool, and assessing the role of frailty assessment tools in preoperative patient optimization.

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“…While clinical decision support (CDS) has permeated medical care, there are few surgical CDS tools to predict resource utilization. Most work has been specialty and/or procedure specific 9 or has addressed questions of comparative effectiveness. 10 , 11 The role of predictive analytics in improving operating room efficiency has been touted for day-of-staffing and resource-allocation decisions.…”

Section: Introductionmentioning

confidence: 99%

Development and Performance of a Clinical Decision Support Tool to Inform Resource Utilization for Elective Operations

et al. 2020

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Key Points Question How can clinical departments implement a clinical decision support tool to predict expected resource use to prioritize elective inpatient surgical procedures? Findings In this prognostic study, predictive models for length of stay, intensive care unit length of stay, mechanical ventilator requirement, and discharge disposition to a skilled nursing facility were developed using historical case data abstracted from the electronic health records of 42 199 patients. These models were integrated into an interactive online dashboard with end-user input and iteratively tested. Meaning Predictive modeling, in conjunction with other contextualizing factors, can be used to inform how to recommence elective inpatient procedures after the coronavirus disease 2019 (COVID-19) pandemic.

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The Effect of Frailty Index on Early Outcomes after Combined Colorectal and Liver Resections

Abstract: The 5-item mFI is significantly associated with 30-day morbidity in patients undergoing combined colorectal and liver resections. It is a tool that can guide surgeons preoperatively in assessing morbidity risk in patients undergoing concomitant resections.

Cited by 47 publications

References 29 publications

Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study

Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study

Frailty and Liver resection: where do we stand?

Development and Performance of a Clinical Decision Support Tool to Inform Resource Utilization for Elective Operations

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