Impact of Frailty on Patient Outcomes after Hartmann's Reversal: A NSQIP Analysis

Association of Frailty With Post-Operative Outcomes of Older Adults Undergoing Elective Ostomy Reversal

BACKGROUND

Ostomy reversal is a common surgical procedure; however, it is not without associated risks. Patient selection for this elective procedure is therefore critically important. Elderly patients represent a growing population and a substantial proportion of patients that present for evaluation after ostomy creation due to the most common etiologies. This study aims to assess the impact of frailty on the outcomes of ostomy reversal among older adults.

METHODS

Patients ≥65 years who underwent ostomy reversal from 2015 to 2019 were identified in the NSQIP database. Frailty was calculated using the 5-item Modified Frailty Index (MFI). Multivariate regression was performed to evaluate the association of frailty with post-operative 30-day mortality, 30-day serious complications, discharge to a facility, and 30-day readmission.

RESULTS

A total of 13,053 patients were included, of which 18.7% were frail (MFI ≥ 2). Patients who underwent colostomy reversal had higher rates of serious complications (P < .0001) and discharge to facility (P < .0001) compared to other reversals. In multivariate analysis, frailty was associated with increased odds of serious complications (OR 1.52, 95% CI 1.31-1.77), discharge to facility (OR 2.14, 95% CI 1.79-2.57), and readmission (OR 1.23, 95% CI 1.04-1.46), but not mortality. Frail patients had predicted probabilities 1.4 times higher for serious complications and 1.7-2.2 times greater for discharge to facility than non-frail patients.

CONCLUSIONS

Among older adults undergoing elective ostomy reversal, frailty is independently associated with increased odds of 30-day serious complications, discharge to facility, and 30-day readmission. As a potentially modifiable risk factor, identification of frailty offers the opportunity for shared decision-making and prehabilitation.

Worsening preoperative functional status increases morbidity and mortality in patients undergoing coronary artery bypass grafting: A propensity matched study of the ACS-NSQIP database

Introduction

Dependent functional status is correlated with increased mortality in patient undergoing coronary artery bypass grafting (CABG). However, patients who are partially dependent and totally dependent may have different peri‑operative outcome profiles. This study aims to retrospectively examine the effect of different levels of functional dependency on post-CABG morbidity and mortality.

Methods

Patients who underwent a CABG from 2005 to 2021 were identified in the ACS-NSQIP database. Subjects were stratified into independent (IFS), partially dependent (PDFS), and totally dependent functional status (TDFS). A 5:1 propensity matching between IFS and each functional dependent group was performed, respectively. The 30-day peri‑operative outcomes of PDFS and TDFS were compared to that of IFS. Peri-operative outcomes between PDFS and TDFS were compared using multivariable logistic regression, adjusted for demographics and co-morbidities.

Results

There were 968 PDFS with 4779 matched IFS and 247 TDFS with 1202 matched IFS. Compared to IFS, PDFS and TDFS had higher mortality, sepsis, bleeding, and length of stay>7 days. TDFS have higher MACE, cardiac/pulmonary/renal complications, and OR return than IFS. Compared to PDFS, TDFS had higher mortality (aOR 1.68, p = 0.03), higher risk of MACE (aOR 1.88, p<0.01), cardiac events (aOR 2.74, p<0.01), perioperative sepsis (aOR 1.73, p = 0.03), pulmonary complications (aOR 2.16, p<0.01), and returning to OR (aOR 1.68, p = 0.02).

Conclusion

Our study shows that dependent functional status is associated with increased morbidity and mortality after CABG. Additional post-CABG complication monitoring and care may be required for TDFS.