R. Venkat1, E. Telemi1, O. Oleksandr1, V. Nfonsam1 1University Of Arizona,Surgery,Tucson, AZ, USA
Introduction: With increasing rates of antibiotic use in the aging population of the U.S., Clostridium difficile (C. difficile) infection of the colon is becoming more prevalent. We sought to evaluate the association between frailty and postoperative outcomes after colectomy for C. difficile colitis.
Methods: NSQIP cross-institutional database was used for this study. Data from 483 patients with a diagnosis of C. difficile colitis was used in the study. 73.71% underwent total (n = 356) and 26.29% partial (n = 127) colectomies. Modified frailty index (mFI) is a previously described and validated 11-variable frailty measure used with NSQIP to assess frailty. Outcome measures included serious morbidity, overall morbidity, Clavien IV (requiring ICU), and Clavien V (mortality) complications.
Results:Median age was 70 years, and BMI was 26.9Kg/m2. 44.4% of patients were males. 98.6% of patients were assigned ASA Class 3 or higher. The median mFI was 0.27 (0 – 0.63). As mFI increased from 0 (non-frail) to 0.36 and above, the overall morbidity and increased from 53.3% to 88.1% and serious morbidity increased from 43.3% to 76.1%, respectively. The Clavien IV complications rate increased from 30.0% to 73.9%. Mortality rate has increased from 6.7% to 46.3%. All results were statistically significant at p<0.01. On a multivariate analysis mFI was independent predictor of overall morbidity (AOR: 12.4, p<0.05) and mortality (AOR: 8.3, p<0.05).
Conclusion:Frailty is associated with increased risk of complications in C. difficile colitis patients undergoing colectomy. The mFI is an easy to use tool and can play an important role in the risk stratification of these patients, who generally have significant morbidity and mortality to begin with.