Frailty predicts morbidity, complications, and mortality in patients undergoing complex abdominal wall reconstruction.

Autor: Joseph, W. J., Cuccolo, N. G., Baron, M. E., Chow, I., Beers, E. H.
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Zdroj: Hernia; Apr2020, Vol. 24 Issue 2, p235-243, 9p
Abstrakt: Purpose: Frailty is becoming an increasingly established risk factor for adverse postoperative outcomes. Given the innately high morbidity involved in complex abdominal wall reconstruction (CAWR) and the propensity for co-morbidities among this patient population, we sought to determine the predictive utility of a frailty index in patients undergoing CAWR.Methods: A retrospective analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database. A total of 70,339 patients undergoing CAWR were identified using CPT codes for ventral hernia repair  ± components separation, ± placement of mesh. A Modified Frailty Index (mFI) was calculated for each patient. Outcomes included overall morbidity, Clavien-Dindo Grade IV (CDIV) complications, and mortality.Results: Overall, 9931 patients had at least one complication associated with their procedure and an average calculated mFI of 0.12 (± 0.11) which was significantly greater than the average mFI noted in patients with no complications (0.077 ± 0.85, p <  0.001). Similarly, average mFI score (0.16  ±  0.12) in patients with CDIV complications (n = 2541) was once again significantly greater than those without CDIV complications (0.080  ±  0.09; p  <  0.001). Multivariable analyses also showed that all individual factors of the mFI were predictive of all-cause and CDIV complications (p  <  0.001). Higher pre-operative mFI conferred a 7.77×  likelihood of all-cause complications, 35.71×  likelihood of CDIV complications, 3.85×  likelihood of surgical site complications, and a 62.05×  likelihood of death (p  <  0.001 for all comparisons).Conclusion: We have shown that frailty as measured by mFI is an accurate predictor of morbidity and mortality in patients undergoing CAWR. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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