Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2016; 22(43): 9544-9553
Published online Nov 21, 2016. doi: 10.3748/wjg.v22.i43.9544
Impact of frailty on approach to colonic resection: Laparoscopy vs open surgery
Catalina Mosquera, Konstantinos Spaniolas, Timothy L Fitzgerald
Catalina Mosquera, Timothy L Fitzgerald, Department of General Surgery, Division of Surgical Oncology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
Konstantinos Spaniolas, Division of Bariatric and Minimally Invasive Surgery, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
Author contributions: Mosquera C performed the research, data analysis and wrote the paper; Spaniolas K contributed to the analysis, supervised the report and clinical adviser; Fitzgerald TL designed the research and contributed to the analysis as well as paper revisions.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of East Carolina University.
Informed consent statement: Patients were not required to give informed consent to the study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Timothy L Fitzgerald, MD, Associate Professor, Department of General Surgery, Division of Surgical Oncology, East Carolina University Brody School of Medicine, 4S24, 600 Moye Boulevard, Greenville, NC 27834, United States. fitzgeraldt@ecu.edu
Telephone: +1-252-7444110 Fax: +1-252-7445777
Received: August 7, 2016
Peer-review started: August 10, 2016
First decision: August 29, 2016
Revised: September 9, 2016
Accepted: October 10, 2016
Article in press: October 10, 2016
Published online: November 21, 2016
Processing time: 103 Days and 12.3 Hours
Abstract
AIM

To understand the influence of frailty on postoperative outcomes for laparoscopic and open colectomy.

METHODS

Data were obtained from the National Surgical Quality Improvement Program (2005-2012) for patients undergoing colon resection [open colectomy (OC) and laparoscopic colectomy (LC)]. Patients were classified as non-frail (0 points), low frailty (1 point), moderate frailty (2 points), and severe frailty (≥ 3) using the Modified Frailty Index. 30-d mortality and complications were used as the primary end point and analyzed for the overall population. Complications were grouped into major and minor. Subset analysis was performed for patients undergoing colectomy (total colectomy, partial colectomy and sigmoid colectomy) and separately for patients undergoing rectal surgery (abdominoperineal resection, low anterior resection, and proctocolectomy). We analyzed the data using SAS Platform JMP Pro version 10.0.0 (SAS Institute Inc., Cary, NC, United States).

RESULTS

A total of 94811 patients were identified; the majority underwent OC (58.7%), were white (76.9%), and non-frail (44.8%). The median age was 61.3 years. Prolonged length of stay (LOS) occurred in 4.7%, and 30-d mortality was 2.28%. Patients undergoing OC were older (61.89 ± 15.31 vs 60.55 ± 14.93) and had a higher ASA score (48.3% ASA3 vs 57.7% ASA2 in the LC group) (P < 0.0001). Most patients were non-frail (42.5% OC vs 48% LC, P < 0.0001). Complications, prolonged LOS, and mortality were significantly more common in patients undergoing OC (P < 0.0001). OC had a higher risk of death and complications compared to LC for all frailty scores (non-frail: OR = 4.7, and OR = 4.67; mildly frail: OR = 2.51, and OR = 2.47; moderately frail: OR = 2.94, and OR = 2.02, severely frail: OR = 2.37, and OR = 2.34, P < 0.05) and an increase in absolute mortality with increasing frailty (non-frail 0.68% OC, mildly frail 1.39%, moderately frail 3.44%, and severely frail 5.83%, P < 0.0001).

CONCLUSION

LC is associated with improved outcomes. Although the odds of mortality are higher in non-frail, there is a progressive increase in mortality with increasing frailty.

Keywords: Frailty; Outcome; Mortality; Morbidity; Colectomy

Core tip: The safety of laparoscopic colectomy is well established; however to date little is understood regarding the influence of frailty on postoperative outcomes. The purpose of our study was to determine the safety of laparoscopic surgery for patient undergoing colonic resection through the frailty spectrum compared to open intervention. After analyzing a total of 94811 patients undergoing colectomy, and classifying them by their frailty scores. We found that laparoscopic surgery is superior to open surgery for patients undergoing colon resection regarding morbidity and mortality. Increases in frailty magnify differences between approaches.