S. Y. Chen1, M. Stem1, S. L. Gearhart1, B. Safar1, S. H. Fang1, J. E. Efron1 1Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA
Introduction:
Functional dependence and frailty are important factors in assessing preoperative risk. No studies to date have compared functional dependence with frailty as predictors of surgical outcomes. We sought to compare the impact of functional dependence and frailty on early outcomes after gastrointestinal (GI) surgery, including readmission.
Methods:
Patients who underwent GI surgery were identified using the ACS-NSQIP database (2012-2015). Functional dependence is defined by NSQIP as “partial or total assistance with performing activities of daily living (bathing, feeding, dressing, toileting, and mobility) in the 30 days prior to surgery.” The 5-item modified frailty index (mFI) consists of: history of severe chronic obstructive pulmonary disease, congestive heart failure, functional status, hypertension requiring medication, and diabetes. Propensity score matching analysis was used to separately match dependent and independent patients, and patients with mFI<3 and mFI≥3 on baseline characteristics. Multivariable logistic regression analysis was utilized. Postoperative outcomes and reasons for readmission were compared. A subgroup analysis of colectomy patients was also performed.
Results:
Of 765,082 patients, 1.71% were dependent, and 1.49% had mFI≥3. Similar outcomes were observed in matched cohorts for dependent and mFI≥3 patients: readmission (15.61% dependent; 5.75% mFI≥3), overall morbidity (37.91%; 34.81%), serious morbidity (19.06%; 17.06%), mortality (6.73%; 5.43%), and reoperation (7.01%; 6.48%). Dependent and mFI≥3 patients had similar and increased odds of outcomes on adjusted multivariable logistic analysis (TABLE) and shared three of the top five indicators for readmission: complication of surgical procedure (11.46% dependent; 11.23% mFI≥3), intestinal obstruction (10.70%; 7.65%), and organ space surgical site infection (7.93%; 8.65%). Comparable outcomes and reasons for readmission were also obtained for dependent and mFI≥ 3 colectomy patients: overall morbidity (51.14% dependent; 49.03% mFI≥ 3), serious morbidity (25.12%; 23.11%), mortality (8.83%; 8.08%), reoperation (8.60%; 7.98%), and readmission (17.79%; 17.75%) Colectomy patients shared four of the top five reasons for readmission: 1) intestinal obstruction without hernia (13.06% dependent; 9.06% mFI≥ 3 ), 2) complications of surgical procedure (9.44%; 10.40%), 3) organ/space SSI (8.06%; 9.40%), and 4) respiratory complications (6.94%; 8.39%).
Conclusion:
Functional dependence and frailty are comparable in predicting outcomes including readmission after GI surgery. Functional dependence should be considered an acceptable and practical alternative for preoperative risk stratification in a clinical setting.
