Predicting loss of independence after high-risk gastrointestinal abdominal surgery: Frailty vs. NSQIP risk calculator

Abstract

BackgroundLoss of independence (LOI) is a significant concern for patients undergoing high-risk abdominal surgery. Although the risk for morbidity and mortality has been well studied, there is a dearth of data on risk for LOI. MethodsThis study utilized NSQIP data from 2015 to 2018 in a retrospective cohort study of patients undergoing high-risk gastrointestinal surgery (e.g. gastric, colorectal, liver, and pancreatic). ResultsThe study included 229,573 patients who were preoperatively functionally independent. Of those, 5.3% experienced LOI. The median age for LOI patients was 74 (CI: 67–81), and 56% were female. The most common race was white (n = 9585), followed by African-American (n = 1223) and other (n = 369). The most common GI procedure was colorectal (65%), followed by the pancreas (23%), liver (8.2%), and gastric (3%). On univariate analysis, age, sex, BMI, race, frailty, and pancreatectomy were associated with LOI. On multivariate analysis age (≥85, OR 18.3 CI:16.9–19.9 p < 0.001), female sex (OR 1.24CI: 1.19–1.29 p < 0.001), BMI <18.5 (OR 1.66 CI:1.48–1.86 p < 0.001), BMI >40 (OR 1.43 CI:1.31–1.56 p < 0.001), African American race (OR 1.20 CI:1.12–1.28 p < 0.001), smoking (OR 1.21 CI:1.14–1.28 p < 0.001), frailty (MFI-5 > 2, OR 4.47 CI:2.63–7.31 p < 0.001), and pancreatectomy (OR 1.86 CI:1.74–1.98 p < 0.001) continued to be associated with LOI. To better define a predictive model, the NSQIP risk calculator was compared to the modified frailty index-5. AUC was 0.80 (CI: 0.797–0.805) and 0.76 (0.760–0.769), respectively. ConclusionLOI occurs in over five percent of patients undergoing high-risk abdominal surgery. LOI occurs more commonly after pancreatectomy or for those who are frail, underweight, or morbidly obese. Both frailty and the NSQIP risk calculator models similarly predicted LOI.