E. Telemi1, O. Trofymenko1, R. Venkat1, V. Nfonsam1 1University Of Arizona,Surgery,Tucson, AZ, USA
Introduction: The rates of ulcerative colitis, an inflammatory bowel disease, have been on the rise in U.S. for last several decades. Colectomy can be performed when other treatment options cannot provide reasonable quality of life to patients with ulcerative colitis or if dysplastic changes are identified on colonoscopy. Frailty has been used to assess the risks of colectomy in patients with various diagnoses.
Methods: NSQIP cross-institutional database was used for this study. The database contains records of more than 139 variables from multiple surgery types around United States from 2005 until 2012. 650 patient records (n = 650) with a primary diagnosis of ulcerative colitis were identified and used in the study. 34.0% underwent laparoscopic (n = 221) and 66.00% open (n = 429) 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 47 years, and BMI was 25.2Kg/m2. 52.8% of patients were males. 43.8% of patients were assigned ASA Class 3 or higher. The median mFI was 0 (0 – 0.54) and median. As mFI increased from 0 (non-frail) to 0.36 and above, the overall morbidity and increased from 26.2% to 68.8% and serious morbidity increased from 16.6% to 68.8%, respectively. The Clavien IV complications rate increased from 3.8% to 56.3%. Mortality rate has increased from 0.2% to 6.3%. All results were statistically significant at p<0.01. On a multivariate analysis mFI was independent predictor of serious morbidity (Adjusted Odd Ratio (AOR): 16.9, p<0.05) and Clavien IV complication rates (AOR: 117.5, p<0.01), independent of age, sex, BMI, ASA category, preoperative albumin, type of colectomy (laparoscopic or open), emergency status of surgery, and wound class.
Conclusion: Morbidity and mortality risks after colectomy in patients can be predicted using frailty. This can help physicians and patients with ulcerative colitis better stratify risks while considering surgical treatment options for these patients