The impact of frailty on outcomes of paraesophageal hernia repair. J Surg Res 2016 May 15;202(2):259-66
Date
05/28/2016Pubmed ID
27229099Pubmed Central ID
PMC4884326DOI
10.1016/j.jss.2016.02.042Scopus ID
2-s2.0-84962860364 (requires institutional sign-in at Scopus site) 44 CitationsAbstract
BACKGROUND: Frailty is a measure of physiological reserve that has been used to predict outcomes after surgical procedures in the elderly. We hypothesized that frailty would be associated with outcomes after paraesophageal hernia (PEH) repair.
METHODS: The National Surgical Quality Improvement Program database (2011-2013) was queried for International Classification of Diseases, Version 9 and Current Procedural Terminology codes associated with PEH repair in patients aged ≥ 60 y. A previously described modified frailty index (mFI), based on 11 clinical variables in National Surgical Quality Improvement Program was used to quantify frailty. Multivariate logistic regression was used to determine the relationship between frailty, complications, and mortality.
RESULTS: Of the 4434 PEH repairs that met inclusion criteria, 885 records were included in the final analysis (20%). Excluded patients were missing one or more variables in the mFI. The rate of complications that were Clavien-Dindo Grade ≥ 3 was 6.1%. Mortality was 0.9%. The readmission rate was 8.2%, and 10.9% of patients were discharged to a facility other than home. Relative to mFI scores of 0, 1, 2, and ≥3, the respective occurrence percentages were as follows; Grade ≥3 complication: 3.2%, 4.7%, 9.8%, and 23.3% (P < 0.0001; odds ratio [OR] 3.51; confidence interval [CI] 1.46-8.46); mortality: 0.0%, 0.9%, 1.8%, and 2.3% (P = 0.0974); discharge to facility other than home: 4.4%, 10.9%, 15.7%, and 31.7% (P < 0.0001; OR 4.07; CI 1.29-12.82); and readmission: 8.9%, 6.8%, 8.5%, and 16.3% (P = 0.1703; OR 1.01; CI 0.36-2.84). Complications and discharge destination were significantly correlated with the mFI.
CONCLUSIONS: Frailty, as assessed by the mFI, is correlated with postoperative complications and discharge to a facility other than home after PEH repair.
Author List
Chimukangara M, Frelich MJ, Bosler ME, Rein LE, Szabo A, Gould JCAuthors
Jon Gould MD Chief, Professor in the Surgery department at Medical College of WisconsinLisa E. Rein Biostatistician III in the Institute for Health and Equity department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Databases, Factual
Female
Frail Elderly
Hernia, Hiatal
Herniorrhaphy
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Postoperative Complications
Retrospective Studies
Risk Factors
Treatment Outcome
