Impact of Frailty on Clinical Outcomes and Hospitalization Costs Following Elective Colectomy
| Autor: | Peyman Benharash, Yas Sanaiha, Joseph Hadaya, Ava Mandelbaum |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Frail Elderly medicine.medical_treatment Odds National cohort 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Hospital Mortality Hospital Costs Risk factor Colectomy Survival analysis Aged Aged 80 and over business.industry 030208 emergency & critical care medicine General Medicine Length of Stay Survival Analysis Patient Discharge United States Total Colectomy Elective Surgical Procedures 030220 oncology & carcinogenesis Emergency medicine Resource use Female Risk assessment business |
| Zdroj: | The American Surgeon. 87:1589-1593 |
| ISSN: | 1555-9823 0003-1348 |
| DOI: | 10.1177/00031348211024233 |
| Popis: | Background Frailty has been increasingly recognized as a risk factor for inferior surgical outcomes and greater resource use. The present study evaluated the impact of a coding-based frailty tool on outcomes of elective colectomy in a national cohort. Study Design Adults undergoing elective colectomy were identified in the 2016-17 Nationwide Readmissions Database. Frailty was defined using the Johns Hopkins 10-domain coding-based binary tool. Generalized linear models were used to examine the association of frailty with in-hospital mortality, nonhome discharge, hospitalization duration (LOS), and inflation-adjusted costs. Kaplan-Meier survival analysis and log-rank test was used to compare readmissions up to 1-year. Results Of 133 175 patients, 10.6% were considered frail. The most common resections were sigmoid (43.9%) and right (34.7%) while total colectomy was least common (2.8%). After adjustment, frailty was associated with greater odds of mortality (3.2, 95% CI 2.8-3.8) and nonhome discharge (6.0, 95% CI 5.5-6.4) as well as a $13,400-increment (95% CI 12,400-14,400) in costs and 4.4-day (95% CI 4.1-4.6) increase in LOS. Nonelective readmissions at 30 days were greater in frail than non-frail groups (14.7% vs. 10.4%, P < .001). Conclusion Frailty is associated with inferior clinical outcomes and increased resource use following elective colectomy. Inclusion of frailty in risk models may facilitate risk stratification and shared decision-making. |
| Databáze: | OpenAIRE |
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