Catalina Mosquera1, Konstantinos Spaniolas2, Timothy L Fitzgerald3. 1. Division of Surgical Oncology, East Carolina University Brody School of Medicine, Greenville, NC. 2. Division of Bariatric and Minimally Invasive Surgery, East Carolina University Brody School of Medicine, Greenville, NC. 3. Division of Surgical Oncology, East Carolina University Brody School of Medicine, Greenville, NC. Electronic address: fitzgeraldt@ecu.edu.
Abstract
BACKGROUND: Measuring frailty may improve patient selection for high-risk procedures. METHODS: Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent elective high-risk operative procedures, and a frailty index was used to classify the patients. RESULTS: Our study analyzed 232,352 patients with a mean age of 65 years; the majority of patients were males (54%) and white (78%). The most common procedure was colectomy (41%), followed by lower extremity bypass (25%), gastrectomy (8%), endovascular abdominal aneurism repair (7%), pancreatectomy (7%), cardiac operation (6%), nephrectomy (3%), and pulmonary resection (2%). A majority of the patients were classified as mildly frail (34%), followed by nonfrail (29%), moderately frail (21%), and severely frail (15%). On univariate analysis, age, race, procedure, sex, and frailty scores were associated with complications, prolonged duration of stay, and 30-day mortality (P < .0001). On multivariate analysis, frailty was associated with complications, prolonged duration of stay, and 30-day mortality. Increasing frailty disproportionately impacted mortality; colectomy showed the greatest mortality in severely frail patients (9.36%), followed by esophagectomy (8.2%), pulmonary resection (6.4%), pancreatectomy (5.8%), cardiac procedures (4.4%), gastrectomy (4.3%), nephrectomy (3.32%), endovascular abdominal aneurism repair (2.49%), and lower extremity bypass (2.41%; P = .0001). A similar association between duration of stay and morbidity with frailty was noted. CONCLUSION: Frailty has a significant impact on postoperative outcomes that varies with type of procedure.
BACKGROUND: Measuring frailty may improve patient selection for high-risk procedures. METHODS: Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent elective high-risk operative procedures, and a frailty index was used to classify the patients. RESULTS: Our study analyzed 232,352 patients with a mean age of 65 years; the majority of patients were males (54%) and white (78%). The most common procedure was colectomy (41%), followed by lower extremity bypass (25%), gastrectomy (8%), endovascular abdominal aneurism repair (7%), pancreatectomy (7%), cardiac operation (6%), nephrectomy (3%), and pulmonary resection (2%). A majority of the patients were classified as mildly frail (34%), followed by nonfrail (29%), moderately frail (21%), and severely frail (15%). On univariate analysis, age, race, procedure, sex, and frailty scores were associated with complications, prolonged duration of stay, and 30-day mortality (P < .0001). On multivariate analysis, frailty was associated with complications, prolonged duration of stay, and 30-day mortality. Increasing frailty disproportionately impacted mortality; colectomy showed the greatest mortality in severely frail patients (9.36%), followed by esophagectomy (8.2%), pulmonary resection (6.4%), pancreatectomy (5.8%), cardiac procedures (4.4%), gastrectomy (4.3%), nephrectomy (3.32%), endovascular abdominal aneurism repair (2.49%), and lower extremity bypass (2.41%; P = .0001). A similar association between duration of stay and morbidity with frailty was noted. CONCLUSION: Frailty has a significant impact on postoperative outcomes that varies with type of procedure.
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