Enhanced Recovery After Surgery Protocols. Does Frailty Play a Role?

Area of Science:

• Colorectal surgery
• Geriatric surgery
• Surgical outcomes research

Background:

• The 5-modified frailty index (mFI) is a validated predictor of surgical mortality.
• Enhanced recovery after surgery (ERAS) protocols are widely used in colorectal surgery.
• The predictive value of frailty for morbidity and length of stay (LOS) may be underestimated in ERAS protocols.

Purpose of the Study:

• To assess the impact of the 5-modified frailty index (mFI) on morbidity, emergency department (ED) visits, readmissions, and LOS in colorectal surgery patients.
• To evaluate the predictive power of frailty in patients undergoing enhanced recovery after surgery (ERAS) protocols.

Main Methods:

• Retrospective review of colectomy patients (January 2016-January 2019) managed with ERAS.
• Calculation of the 5-mFI score based on five comorbidities: CHF, diabetes, COPD, functional status, and HTN.
• Multivariate analysis to determine the association between 5-mFI score and outcomes (morbidity, ED visits, readmissions, LOS).

Main Results:

• Frailer patients (higher 5-mFI) experienced significantly more ED visits, readmissions, and longer LOS.
• Congestive heart failure (CHF) was associated with prolonged LOS; hypertension (HTN) with ED visits.
• Elderly patients with higher 5-mFI scores (3-4) had significantly longer LOS and increased likelihood of ED visits and readmissions.

Conclusions:

• Increased 5-mFI in elderly colorectal surgery patients is linked to higher ED visits, readmissions, and LOS.
• The 5-mFI is a valuable tool for assessing frailty in elderly patients undergoing colorectal procedures.
• Frailty assessment is essential for optimizing care and predicting outcomes in this population.