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

Table 3 Univariate and multivariate complication analysis by frailty group patients undergoing colorectal resection, ACS-NSQIP 2005-2012

Characteristic	Complication n (%)	P value	OR (95%CI), P value
Non frail (n = 42507)
Age	Yes: 53.74 ± 15.81	< 0.0001	0.94 (0.95-1.05), < 0.001
	No: 53.94 ± 14.93
Race
AA	719 (25.63)	< 0.0001	1.29 (1.18-1.41), < 0.0001
White	6736 (20.07)		Ref
Other	362 (19.37)		0.98 (0.87-1.10), 0.77
Unknown	906 (21.24)		1.06 (0.98-1.15), 0.11
Gender
Male	4191 (20.73)	0.30
Female	4532 (20.33)
Type of intervention			< 0.0001
APR	55 (21.91)		0.87 (0.64-1.18), 0.37
LAR	1858 (18.32)		0.97 (0.91-1.03), 0.34
TPC	733 (28.95)		1.71 (1.55-1.87), < 0.0001
Total colectomy	536 (31.66)		1.77 (1.59-1.98), < 0.0001
Partial colectomy	18.58 (18.32)		Ref
Sigmoid colectomy	573 (34.90)		1.88 (1.69-2.10), < 0.0001
Procedure
Open	6143 (25.97)	< 0.0001	2.07 (1.97-2.18), < 0.0001
Lap	2580 (13.68)		Ref
Characteristic, mildly frail (n = 35596)
Age	Yes: 65.81 ± 13.06	< 0.0001	0.94 (0.94-0.95), < 0.0001
	No: 65.00 ± 12.17
Race
AA	1154 (27.90)	< 0.0001	1.15 (1.07-1.24), 0.0002
White	6637 (24.54)		Ref
Other	291 (20.07)		0.81 (0.70-0.93), 0.0026
Unknown	734 (25.78)		1.06 (0.97-1.16), 0.18
Gender		0.34
Male	4017 (25.09)		-
Female	4829 (24.66)
Type of intervention		< 0.0001
APR	61 (31.12)		1.09 (0.80-1.48), 0.55
LAR	1918 (23.72)		1.01 (0.95-1.08), 0.58
TPC	341 (37.47)		1.78 (1.54-2.05), < 0.0001
Total colectomy	370 (39.07)		1.75 (1.53-2.01), < 0.0001
Partial colectomy	5500 (23.12)		Ref
Sigmoid colectomy	656 (39.40)		1.78 (1.60-1.98), < 0.0001
Procedure
Open	6360 (30.52)	< 0.0001	2.05 (1.94-2.16), < 0.00001
Lap	2486 (16.85)		Ref
Characteristic moderately frail (n = 11774)
Age	Yes: 70.480 ± 11.81	< 0.0001	0.99 (0.99-1.00), < 0.0001
	No: 70.42 ± 10.82
Race
AA	472 (37.19)	0.0013	1.20 (1.06-1.37), 0.003
White	2996 (32.21)		Ref
Other	118 (32.07)		1.01 (0.80-1.26), 0.93
Unknown	299 (35.81)		1.12 (0.96-1.31), 0.13
Gender
Male	2029 (31.75)	0.0017	0.92 (00.85-1.00), 0.06
Female	1856 (34.48)		Ref
Type of intervention		< 0.0001
APR	19 (35.85)		0.97 (0.52-1.70), 0.92
LAR	726 (32.12)		1.05 (0.95-1.17), 0.28
TPC	110 (50.23)		2.10 (1.49-2.63), < 0.0001
Total colectomy	182 (50.56)		2.05 (1.65-2.55), < 0.0001
Partial colectomy	2522 (30.70)		Ref
Sigmoid colectomy	326 (48.95)		1.96 (1.66-2.31), < 0.0001
Procedure
Open	2896 (38.38)	< 0.0001	1.89 (1.73-2.07), < 0.0001
Lap	989 (23.48)		Ref
Characteristic severely frail (n = 4934)
Age	Yes: 71.89 ± 10.50	0.02	0.96 (0.040-0.17), < 0.0001
	No: 72.54 ± 9.57
Race
AA	295 (51.94)	0.042	1.18 (0.98-1.42), 0.06
White	1822 (45.96)		Ref
Other	51 (42.15)		0.90 (0.682-1.33), 0.61
Unknown	133 (45.96)		1.02 (0.79-1.32), 0.84
Gender
Male	1308 (42.27)	0.31	-
Female	993 (45.82)
Type of intervention		< 0.0001
APR	12 (50)		1.05 (0.46-2.38), 0.89
LAR	350 (43.10)		0.98 (0.84-1.15), 0.85
TPC	53 (53.54)		1.27 (0.85-1.91), 0.23
Total colectomy	134 (63.81)		1.96 (1.46-2.64), < 0.0001
Partial colectomy	1499 (44.21)		Ref
Sigmoid colectomy	253 (63.57)		1.94 (1.56-2.44), < 0.0001
Procedure
Open	1842 (51.05)	< 0.0001	1.83 (1.60-2.09), < 0.0001
Lap	459 (3462)		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.