Impact of frailty on approach to colonic resection: Laparoscopy vs open surgery

Table 2 Univariate and multivariate mortality analysis by frailty group patients undergoing colon resection, ACS-NSQIP 2005-2012

Characteristic	Mortality n (%)	P value	OR (95%CI), P value
Non frail (n = 42507)
Age	Yes: 65.22 ± 15.23	< 0.0001	0.94 (0.95-1.05), < 0.0001
	No: 53.84 ± 15.09
Race
AA	20 (0.71)	0.60	-
White	186 (0.55)
Other	10 (0.54)
Unknown	20 (0.47)
Gender
Male	122 (0.60)	0.20	1.34 (1.03-1.75), 0.028
Female	114 (0.51)		Ref
Type of intervention		< 0.0001
APR	1 (0.40)		0.45 (0.02-2.04), 0.36
LAR	31 (0.31)		0.53 (0.35-0.77), 0.0008
TPC	8 (0.32)		0.81 (0.36-1.57), 0.56
Total colectomy	15 (0.89)		1.82 (1.02-3.04), 0.04
Partial colectomy	162 (0.62)		Ref
Sigmoid colectomy	19 (1.16)		1.18 (0.66-1.96), 0.54
Procedure
Open	204 (0.86)	< 0.0001	4.65 (3.16-6.82), < 0.0001
Lap	32 (0.17)		Ref
Characteristic mildly frail (n = 35596)
Age	Yes: 72.84 ± 12.25	< 0.0001	0.94 (0.95-1.05), < 0.0001
	No: 65.75 ± 12.36
Race		0.59
AA	68 (1.64)
White	453 (1.67)
Other	20 (1.38)
Unknown	57 (1.92)
Gender		0.006
Male	302 (1.89)		1.58 (1.33-1.88), < 0.0001
Female	296 (1.51)		Ref
Type of intervention		< 0.0001
APR	5 (2.55)		1.14 (0.34-2.73), 0.79
LAR	85 (1.05)		0.68 (0.53-1.87), 0.0018
TPC	14 (1.54)		1.07 (0.58-1.81), 0.79
Total colectomy	31 (3.27)		1.94 (1.28-2.84), 0.00025
Partial colectomy	405 (1.70)		Ref
Sigmoid colectomy	58 (3.48)		1.77 (1.30-2.36), 0.0003
Procedure
Open	470 (2.26)	< 0.0001	2.35 (1.92-2.91), < 0.0001
Lap	128 (0.87)		Ref
Characteristic moderately frail (n = 11744)
Age	Yes: 74.7 ± 10.95	< 0.0001	0.96 (0.11-17.47), < 0.0001
	No: 70.28 ± 11.2
Race
AA	49 (3.86)	0.65	-
White	368 (3.96)
Other	13 (3.53)
Unknown	40 (4.76)
Gender		0.34
Male	265 (4.15)		-
Female	205 (3.81)
Type of intervention		< 0.0001
APR	29 (3.77)		0.89 (0.14-2.92), 0.87
LAR	54 (2.39)		0.68 (0.49-0.91), 0.018
TPC	13 (5.94)		1.70 (0.88-2.98), 0.10
Total colectomy	28 (7.78)		2.29 (1.48-3.40), 0.0003
Partial colectomy	317 (3.86)		Ref
Sigmoid colectomy	56 (8.41)		2.08 (1.50-2.83), < 0.001
Procedure
Open	395 (5.22)	< 0.0001	2.70 (2.08-3.54), < 0.0001
Lap	75 (1.78)		Ref
Characteristic: Severely frail (n = 4934)
Age	Yes: 75.92 ± 9.51	< 0.0001	0.96 (0.15-13.07), < 0.0001
	No: 71.94 ± 10.02
Race
AA	50 (8.80)	0.42	-
White	381 (9.61)
Other	7 (5.79)
Unknown	24 (8.54)
Gender
Male	281 (10.16)	0.03	1.42 (1.16-1.75), 0.0006
Female	181 (8.35)		Ref
Type of intervention		< 0.0001
APR	2 (8.33)		0.75 (0.12-2.62), 0.69
LAR	46 (5.67)		0.63 (0.45-0.88), 0.0058
TPC	10 (10.10)		1.15 (0.55-2.15), 0.68
Total colectomy	35 (16.67)		2.07 (1.38-3.03), 0.0006
Partial colectomy	299 (8.82)		Ref
Sigmoid colectomy	70 (17.59)		1.94 (1.41-2.62), < 0.0004
Procedure
Open	394 (10.92)	< 0.0001	2.13 (1.62-2.84), < 0.0001
Lap	68 (5.13)		Ref

Lap: Laparoscopic; ACS-NSQIP: American College of surgeons National surgical Quality improvement program; AA: African Americans; APR: Abdominoperineal resection; LAR: Low anterior resection; TPC: Total abdominal proctocolectomy; LOS: Length of stay.