Decoding the Effect of Frailty vs. Physiologic Age in Octogenarian and Nonagenarian Colectomy Outcomes for Colon Cancer
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background/Objectives: Colorectal surgeons continue to care for an aging cancer population with increasing co-morbidities and frailty. Frailty, characterized by a systemic physiologic decline associated with aging, is an increasingly popular focus in surgical outcomes research. This retrospective study aimed to investigate the impact of frailty on outcomes in the octogenarian and nonagenarian populations undergoing surgical treatment for colon cancer. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) colectomy-targeted variables dataset from 2015 to 2021 were utilized for this analysis. Inclusion criteria included patients 80 years of age and older. Frailty was assessed using the 5-factor modified frailty index (mFI-5). The study examined post-operative outcomes across frailty groups in this population. Results: From 2015-2021, 10,815 patients >=80 years old with colon cancer underwent colectomy, 11.9% (n=1,285) were 90 years or older. Frailty significantly impacted post-operative colectomy outcomes in this population. On univariate analysis, frail patients had higher rates of pneumonia (p=0.002), unplanned intubation (p<0.001), mechanical ventilation for >48 hours (p=0.027), stroke (p<0.001), myocardial infarction (p = 0.010), sepsis (p=0.039), unplanned re-operation (p=0.029), and readmission (p < 0.001) compared to non-frail patients. On multivariate analysis, severe frailty (mFI-5 of 2 or more) was associated with an increased odds of unplanned intubation (p=0.003), length of stay >5 days (p<0.001), readmission (p<0.001), and mortality (p=0.007) compared to non-frail patients. Conclusions: Frailty plays a critical role in influencing the outcomes of octogenarians and nonagenarians undergoing colectomy for colon cancer within the NSQIP dataset. Future work should investigate whether addressing frailty prior to surgery in this population can improve patient’s post-operative course.