O. Trofymenko1, R. Venkat1, E. Telemi1, V. Nfonsam1 1University Of Arizona,Surgery,Tucson, AZ, USA
Introduction: Colorectal cancer is the third most common cancer in men and women in the U.S. and is the second leading cause of cancer death in both sexes. Colectomies play an important role as a treatment option for people with colorectal malignancy. Frailty has been noted as a powerful predictive preoperative tool for 30-day postoperative complications.
Methods: The NSQIP participant use file was queried to identify 26,314 patients with malignant colorectal neoplasm. 52.29% underwent laparoscopic (n = 12,555) and 47.71% open (n = 13,759) colectomies. A previously described and validated modified frailty index (mFI) was calculated on the basis of NSQIP variables. Our primary outcomes were overall morbidity, Clavien class IV (requiring critical care support) and Clavien class V (mortality) complications.
Results:Median age was 69 years, and BMI was 27.0Kg/m2. 50.3% of patients were males. 56.0% of patients were ASA Class 3 or higher. The median mFI was 0.09 (0 – 0.73). As mFI increased from 0 (non-frail) to 0.36 and above, the overall morbidity increased from 14.6% to 39.3% (p<0.01) and serious morbidity increased from 6.8% to 22.8% (p<0.01), respectively. The Clavien IV complications rate increased from 2.4% to 16.8% and the mortality rate increased from 0.7% to 7.8%, respectively (p<0.01). On multivariate analysis mFI was independent predictor of serious morbidity (Adjusted Odd Ratio (AOR): 6.2, p<0.01), overall morbidity (AOR: 5.0, p<0.01), Clavien IV complication rates (AOR: 13.0, p<0.01) and mortality (AOR: 4.4, p<0.01).
Conclusion:A simplified frailty index, obtained by easily identifiable patient characteristics, significantly predicts morbidity and mortality after colectomy for cancer. Assessment of frailty may facilitate perioperative risk stratification, as well as help identify and counsel high-risk patients.