Frailty predicts morbidity and mortality after colectomy for clostridium difficile colitis

Raghunandan Venkat, Viraj Pandit, Edwin Telemi, Oleksandr Trofymenko, Twinkle K. Pandian, Valentine N Nfonsam

Research output: Contribution to journalArticle

Abstract

Frailty has been noted as a powerful predictive preoperative tool for 30-day postoperative complications. We sought to evaluate the association between frailty and postoperative outcomes after colectomy for Clostridium difficile colitis. The National Surgical Quality and Improvement Program cross-institutional database was used for this study. Data from 470 patients with a diagnosis of C. difficile colitis were used in the study. Modified frailty index (mFI) is a previously described and validated 11-variable frailty measure used with the National Surgical Quality and Improvement Program to assess frailty. Outcome measures included serious morbidity, overall morbidity, and Clavien IV (requiring ICU) and Clavien V (mortality) complications. The median age was 70 years and body mass index was 26.9 kg/m2. 55.6 per cent of patients were females. 98.5 per cent of patients were assigned American Society of Anesthesiologists Class III or higher. The median mFI was 0.27 (0–0.63). Because mFI increased from 0 (non-frail) to 0.55 and above, the overall morbidity increased from 53.3 per cent to 84.4 per cent and serious morbidity increased from 43.3 per cent to 78.1 per cent. The Clavien IV complication rate increased from 30.0 per cent to 75.0 per cent. The mortality rate increased from 6.7 per cent to 56.2 per cent. On a multivariate analysis, mFI was an independent predictor of overall morbidity (AOR: 13.0; P < 0.05), mortality (AOR: 8.8; P 5 0.018), cardiopulmonary complications (AOR: 6.8; P 5 0.026), and prolonged length of hospital stay (AOR: 6.6; P 5 0.045). Frailty is associated with increased risk of complications in C. difficile colitis patients undergoing colectomy. mFI is an easy-to-use tool and can play an important role in the risk stratification of these patients who generally have significant morbidity and mortality to begin with.

Original languageEnglish (US)
Pages (from-to)628-632
Number of pages5
JournalAmerican Surgeon
Volume84
Issue number5
StatePublished - May 1 2018

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Clostridium difficile
Colectomy
Colitis
Morbidity
Mortality
Quality Improvement
Length of Stay
Body Mass Index
Multivariate Analysis
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Venkat, R., Pandit, V., Telemi, E., Trofymenko, O., Pandian, T. K., & Nfonsam, V. N. (2018). Frailty predicts morbidity and mortality after colectomy for clostridium difficile colitis. American Surgeon, 84(5), 628-632.

Frailty predicts morbidity and mortality after colectomy for clostridium difficile colitis. / Venkat, Raghunandan; Pandit, Viraj; Telemi, Edwin; Trofymenko, Oleksandr; Pandian, Twinkle K.; Nfonsam, Valentine N.

In: American Surgeon, Vol. 84, No. 5, 01.05.2018, p. 628-632.

Research output: Contribution to journalArticle

Venkat, R, Pandit, V, Telemi, E, Trofymenko, O, Pandian, TK & Nfonsam, VN 2018, 'Frailty predicts morbidity and mortality after colectomy for clostridium difficile colitis', American Surgeon, vol. 84, no. 5, pp. 628-632.
Venkat R, Pandit V, Telemi E, Trofymenko O, Pandian TK, Nfonsam VN. Frailty predicts morbidity and mortality after colectomy for clostridium difficile colitis. American Surgeon. 2018 May 1;84(5):628-632.
Venkat, Raghunandan ; Pandit, Viraj ; Telemi, Edwin ; Trofymenko, Oleksandr ; Pandian, Twinkle K. ; Nfonsam, Valentine N. / Frailty predicts morbidity and mortality after colectomy for clostridium difficile colitis. In: American Surgeon. 2018 ; Vol. 84, No. 5. pp. 628-632.
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