1. Evaluating frailty using the modified frailty index for colonic diverticular disease surgery: analysis of the national inpatient sample 2015–2019.
- Author
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McKechnie, Tyler, Jessani, Ghazal, Bakir, Noor, Lee, Yung, Sne, Niv, Doumouras, Aristithes, Hong, Dennis, and Eskicioglu, Cagla
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RISK assessment , *COLON diverticulum , *T-test (Statistics) , *BODY mass index , *FRAIL elderly , *MULTIPLE regression analysis , *HOSPITAL mortality , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *CHI-squared test , *DISCHARGE planning , *SEVERITY of illness index , *SURGICAL complications , *DISEASES , *LONGITUDINAL method , *ODDS ratio , *MEDICAL records , *ACQUISITION of data , *POSTOPERATIVE period , *LENGTH of stay in hospitals , *DATA analysis software , *CONFIDENCE intervals , *MEDICAL care costs , *REGRESSION analysis , *COMORBIDITY , *SENSITIVITY & specificity (Statistics) , *DISEASE risk factors - Abstract
Background: Frailty has been associated with increased postoperative mortality and morbidity; however, the use of the modified frailty index (mFI-11) to assess patients undergoing surgery for diverticular disease has not been widely assessed. This paper aims to examine frailty, evaluated by mFI-11, to assess postoperative morbidity and mortality among patients undergoing operative intervention for colonic diverticular disease. Methods: We used data from the Healthcare Cost and Utilization Project National Inpatient Sample (October 1, 2015–December 31, 2019). ICD-10-CM codes were utilized to identify a cohort of adult patients with a primary admission diagnosis of diverticulitis. mFI-11 items were adapted to correspond with ICD-10-CM codes. Patients were stratified into robust (mFI < 0.27) and frail (mFI ≥ 0.27) groups. Primary outcomes were in-hospital postoperative morbidity and mortality. Secondary outcomes included system-specific postoperative complications, length of stay (LOS), total admission cost, and discharge disposition. Multivariable regression models were fit. Results: Of the 26,826 patients, there were 24,194 patients with mFI-11 < 0.27 (i.e., robust) and 2,632 patients with mFI-11 ≥ 0.27 (i.e., frail). Adjusted analysis showed significant increases in postoperative mortality (aOR 2.16, 95% CI 1.38–3.38, p = 0.001) and overall postoperative morbidity (aOR 1.84, 95% CI 1.65–2.06, p < 0.001). LOS was higher in the frail group (MD 1.78 days, 95% CI 1.46–2.11, p < 0.001) as well as total cost (MD $25,495.19, 95% CI $19,851.63-$31,138.75, p < 0.001). Conclusion: In the elective setting, a high mFI-11 (i.e., presence of the variables comprising the index) could alert clinicians to the possibility of implementing preoperative optimization strategies. In the emergent setting, a high mFI-11 may help guide prognostication for these vulnerable patients. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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