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Using frailty to predict who will fail early discharge after laparoscopic colorectal surgery with an established
Deborah S Keller1, Blake Bankwitz, Tamar Nobel
11Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio 2Department of Statistics, Case Western Reserve University, Cleveland, Ohio 3Case Western Reserve University School of Medicine, Cleveland, Ohio 4Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio.
Background:
Despite laparoscopy and enhanced recovery pathways, some patients do not attain early discharge. Frailty is generally accepted as a marker of increased risk, complications, and mortality. Frailty may have the potential to identify patient outcomes.
Purpose:
The aim of this study was to evaluate frailty as a predictor of patients who might fail early discharge.
Setting:
This study was conducted at a tertiary referral center.
Design:
This was a case-matched study.
Patients:
Elective abdominal laparoscopic colorectal cases from 2009 to 2012 were selected.
Methods:
Review of a prospective database matched all cases with a postoperative day of discharge of ≤3 days to a >3 day of discharge cohort. All patients followed a standardized enhanced recovery pathway.
Statistical Analysis:
Categorical and ordinal variables were analyzed with the Student t test or Fisher exact test, and correspondence analysis evaluated the relationship between length of stay and the Modified Frailty Index.
Main Outcome Measure:
The primary outcome measure was the relationship between length of stay and the Modified Frailty Index.
Results:
There were 464 ≤3 day and 388 >3 day patients. The groups were similar in demographics and comorbidities. There were significant differences in the Modified Frailty Index (p < 0.01), operative time (p < 0.01), postoperative complications (p < 0.01), 30-day readmissions (p = 0.03), and 30-day reoperation rate (p < 0.01). Significantly more patients were discharged home in the ≤3 day cohort. Correspondence analysis demonstrated a higher Modified Frailty Index was indicative of longer length of stay. A Modified Frailty Index of 0 was strongly related to a length of stay 0 to 3 days, and a Modified Frailty Index of 2 was strongly related to a 8- to 14-day stay.
Limitations:
This was a single-center study performed on a retrospective data set.
Conclusions:
Patients undergoing elective colorectal surgery with a higher Modified Frailty Index were more likely not to attain early discharge. Despite similar demographics, the Modified Frailty Index could discriminate between patient outcomes, and correlated with longer operating times, length of stay, and readmissions. By using a prospective score to identify patients at risk for not achieving early discharge preoperatively, resources and postoperative support can be better allocated.
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