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

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 Am...

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Bibliographic Details
Published in:Colorectal disease 2019-10, Vol.21 (10), p.1192-1205
Main Authors: AL‐Khamis, A., Warner, C., Park, J., Marecik, S., Davis, N., Mellgren, A., Nordenstam, J., Kochar, K.
Format: Article
Language:English
Subjects:
colorectal
Colorectal surgery
Frailty
Medical personnel
Morbidity
Mortality
Multivariate analysis
NSQIP
outcomes
Patients
Physiology
postoperative
Quality control
Statistical analysis
Stress (physiology)
Surgeons
Surgery
Surgical instruments
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Summary: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 
ISSN:1462-8910
1463-1318
DOI:10.1111/codi.14725