Abstract
Background
The outcomes of operative repair of intestinal-cutaneous fistulas vary widely throughout
the literature. We aimed to investigate whether the modified frailty index-5 is a
reliable tool to account for physiologic reserve and whether it serves as a predictor
of Clavien-Dindo grade IV complications in those with intestinal-cutaneous fistulas
undergoing operative repair.
Methods
We queried the American College of Surgeons National Surgical Quality Improvement
Program 2006 to 2017 database to include patients who underwent intestinal-cutaneous
fistulas repair. The outcome of interest was 30-day Clavien-Dindo grade IV complications.
The incidence of 30-day post-operative Clavien-Dindo grade IV complications were evaluated
based on calculated modified frailty index-5 score. Multivariable logistic regression
analyses were performed to assess the association of Clavien-Dindo grade IV complications
and modified frailty index-5.
Results
A total of 3,995 patients were identified who underwent an intestinal-cutaneous fistulas
repair. The median age (interquartile range) was 57 years (46, 67), and most patients
were female (2,143 [53.7%]), White (3,206 [80.3%]), and 1,512 (38.2%) were obese.
After adjusting for relevant covariates such as demographics, comorbidities, and operative
details, modified frailty index-5 was independently associated with Clavien-Dindo
grade IV complications (odds ratio = 2.81, 95% confidence interval 1.64–4.82; P < .001).
Conclusion
Modified frailty index-5 is an independent predictor of Clavien-Dindo grade IV complications
following intestinal-cutaneous fistulas repair. It can be used to account for physiologic
reserve, thus reducing the variability of outcomes reported for intestinal-cutaneous
fistulas repair.
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References
- An analysis of predictive factors for healing and mortality in patients with enterocutaneous fistulas.Aliment Pharmacol Ther. 2008; 28: 1111-1121
- Guided treatment improves outcome of patients with enterocutaneous fistulas.World J Surg. 2012; 36: 2341-2348
- Complications of enterocutaneous fistulas and their management.Clin Colon Rectal Surg. 2010; 23: 209-220
- Factors predictive of recurrence and mortality after surgical repair of enterocutaneous fistula.J Gastrointest Surg. 2012; 16: 156-163
- Definitive surgical closure of enterocutaneous fistula: outcome and factors predictive of increased postoperative morbidity.Colorectal Dis. 2014; 16: 209-218
- Risk factors for recurrence after repair of enterocutaneous fistula.Arch Surg. 2009; 144: 500-505
- Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes.World J Surg. 2008; 32 (discussion 444): 436-443
- Definitive surgical treatment of enterocutaneous fistula: outcomes of a 23-year experience.JAMA Surg. 2013; 148: 118-126
- Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center.J Multidiscip Healthc. 2014; 7: 365-370
- The frailty syndrome: definition and natural history.Clin Geriatr Med. 2011; 27: 1-15
- Frailty and 10-year mortality in community-living Mexican American older adults.Gerontology. 2009; 55: 644-651
- A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men.J Am Geriatr Soc. 2009; 57: 492-498
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- New 5-factor modified frailty index using American College of Surgeons NSQIP data.J Am Coll Surg. 2018; 226: 173-181.e8
- Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging.J Gerontol A Biol Sci Med Sci. 2004; 59: 1310-1317
- Simplified frailty index to predict adverse outcomes and mortality in vascular surgery patients.Ann Vasc Surg. 2013; 27: 904-908
- Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery.JAMA Otolaryngol Head Neck Surg. 2013; 139: 783-789
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
- Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery.J Neurosurg Spine. 2016; 25: 537-541
- The modified 5-item frailty index: a concise and useful tool for assessing the impact of frailty on postoperative morbidity following elective posterior lumbar fusions.World Neurosurg. 2019; 124: e626-e632
- A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair.Surg Endosc. 2017; 31: 2509-2519
- Use Guide for the 2012 ACS NSQIP Participant Use Data File.(Accessed)
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Nutritional management in enterocutaneous fistula. What is the evidence?.Malays J Med Sci. 2015; 22: 6-16
- Acute-phase proteins: as diagnostic tool.J Pharm Bioallied Sci. 2011; 3: 118-127
- Thirty-day outcomes in the operative management of intestinal-cutaneous fistulas: a NSQIP analysis [e-pub ahead of print].Am J Surg. 2020; https://doi.org/10.1016/j.amjsurg.2020.08.038
- The 5-item modified frailty index is predictive of 30-day postoperative complications in patients undergoing kyphoplasty vertebral augmentation.World Neurosurg. 2018; 116: e225-e231
- Use of a 5-Item modified frailty index for risk stratification in patients undergoing surgical management of distal radius fractures.J Hand Surg Am. 2018; 43: 701-709
- Modified frailty index predicts early outcomes after colorectal surgery: an ACS-NSQIP study.Colorectal Dis. 2019; 21: 1192-1205
- Assessment of morbidity and mortality after esophagectomy using a modified frailty index.Ann Thorac Surg. 2013; 96: 1240-1245
- A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans.J Nutr Health Aging. 2012; 16: 601-608
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Frailty and comorbidity are independent predictors of outcome in patients referred for pre-dialysis education.Clin Kidney J. 2016; 9: 324-329
- Factors predictive of recurrence and mortality after surgical repair of enterocutaneous fistula.J Gastrointest Surg. 2012; 16 (discussion 163-164): 156-163
- Predicting risk of death in general surgery patients on the basis of preoperative variables using American College of Surgeons National Surgical Quality Improvement Program data.Perm J. 2012; 16: 10-17
Cima RR, Lackore KA, Nehring SA, et al. How best to measure surgical quality? Comparison of the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) postoperative adverse events at a single institution.
Article info
Publication history
Published online: January 04, 2021
Accepted:
November 12,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
