Abstract
Background Elderly and frail patients undergo open emergency colectomies and are at greater risk for complications. The relationship between frailty and open emergent colectomies is yet unexplored. Objective The purpose of this study was to evaluate the relationship between frailty and outcomes after open emergent colorectal surgery. Design Using the American College of Surgeons National Quality Improvement Program database, a validated modified frailty index was used, along with logistic regression, to assess the relationship between frailty and outcomes. Main Outcome Measures Outcomes included mortality (primary), Clavien-Dindo Complication Grade >3, reintubation, ventilator >48 hours, and reoperation (secondary). Results The rates for 30-day mortality, Clavien-Dindo Grade >3, reintubation, ventilator > 48 hours, and reoperation in our cohort were 16.6%, 36.9%, 8.6%, 23.9%, and 15.0%, respectively. There was a statistically significant increase in prevalence of all outcomes with increasing frailty. Limitations A causal relationship between frailty and complications cannot be established in a retrospective analysis. Also, extrapolation of our data to reflect outcomes beyond 30 days must be done with caution. Conclusions Frailty is a statistically significant predictor of mortality and morbidity after open emergent colectomies and can be used in an acute care setting.
Highlights
Nonelective open colectomies are among the highest national burden for acute care surgery, with significant morbidity, mortality, and hospital cost [1]
Of those classified with an modified frailty index” (mFI) score of 0, 22 percent were younger than 41 years
MFI cohorts of 3 and 4 or greater had a predominance of older patients with 81.7% and 84.2% being at least 60 years of age
Summary
Nonelective open colectomies are among the highest national burden for acute care surgery, with significant morbidity, mortality, and hospital cost [1]. And frail patients undergo open emergency colectomies and are at greater risk for complications. The relationship between frailty and open emergent colectomies is yet unexplored. The purpose of this study was to evaluate the relationship between frailty and outcomes after open emergent colorectal surgery. Outcomes included mortality (primary), Clavien-Dindo Complication Grade >3, reintubation, ventilator >48 hours, and reoperation (secondary). The rates for 30-day mortality, Clavien-Dindo Grade >3, reintubation, ventilator > 48 hours, and reoperation in our cohort were 16.6%, 36.9%, 8.6%, 23.9%, and 15.0%, respectively. Frailty is a statistically significant predictor of mortality and morbidity after open emergent colectomies and can be used in an acute care setting
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