Modified Frailty Index Predicts Postoperative Complications Following Parastomal Hernia Repair.

Autor:	Khan M; Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA., Patnaik R; Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA., Lue M; Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA., Dao Campi H; Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA., Montorfano L; Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA., Sarmiento Cobos M; Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA., Valera RJ; Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA., Rosenthal RJ; Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA., Wexner SD; Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2024 Feb; Vol. 90 (2), pp. 207-215. Date of Electronic Publication: 2023 Aug 26.
DOI:	10.1177/00031348231198102
Abstrakt:	Background: The 5-factor frailty index (5-mFI), validated frailty index with Spearmen rho correlation of .95 and C statistic >.7 for predicting postoperative complications, can be preoperatively used to stratify patients prior to parastomal hernia repairs. Methods: Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database identified patients from 2015 to 2020. 5-mFI scores were calculated by adding one point for each comorbidity present: diabetes mellitus, congestive heart failure (CHF), hypertension requiring medication, severe chronic obstructive pulmonary disease (COPD), non-independent functional status. Primary endpoint was 30-day overall complications; secondary endpoints were 30-day readmission, reoperation, and discharge to care facility. Results: 2924 (52.2% female) patients underwent elective parastomal hernia repair. Univariate analysis showed 5-mFI > 2 had higher rates of overall ( P = .008), pulmonary ( P = .002), cardiovascular ( P = .003)), hematologic ( P = .003), and renal ( P = .002) complications and higher rates of readmission ( P = .009), reoperation ( P = .001), discharge to care facility ( P < .001), and death ( P < .001). Multivariate analysis identified a 5-mFI of 2 or more as an independent risk factor for overall complications [OR: 1.40, 1.03-1.78; P = .032], pulmonary complications [2.97, 1.63-5.39; P < .001], hematological complications [1.60, 1.03-2.47; P = .035], renal complications [2.04, 1.19-3.46; P = .009], readmission [1.54, 1.19-1.99; P < .001], and discharge to facility [2.50, 1.66-3.77; P < .001]. Reoperation was not signification on multivariate analysis. Conclusions: Parastomal hernia repair patients with 5-mFI score of > 2 had higher risk of renal, cardiovascular, pulmonary, and hematologic complications, readmissions, longer hospitalization, discharge to care facility, and mortality, and can be useful during preoperative risk stratification. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: None of the authors have relevant financial conflicts of interest to disclose. Dr Wexner reports received consulting fees from ARC/Corvus, Astellas, Baxter, Becton Dickinson, GI Supply, ICON Language Services, Intuitive Surgical, Leading BioSciences, Livsmed, Medtronic, Olympus Surgical, Stryker, Takeda and receiving royalties from Intuitive Surgical and Karl Storz Endoscopy America Inc.
Databáze:	MEDLINE
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