title: Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program: exploring frailty and aggressive laparoscopic approaches.
abstract: BACKGROUND
  Colectomy patients experience a broad set of adverse outcomes. Complications requiring critical care support are common in this group. We hypothesized that as frailty increases, the risk of Clavien class IV and V complications will increase in colectomy patients.
  
  
  METHODS
  Using the National Surgical Quality Improvement Program (NSQIP) participant use files for 2005-2009, we identified patients who underwent laparoscopic and open colectomies by Current Procedural Terminology code. Using the Clavien classification for postoperative complications, we identified NSQIP data points most consistent with Clavien class IV requiring intensive care unit (ICU) care or class V complications (death). We used a modified frailty index with 11 variables based on mapping the Canadian Study of Health and Aging Frailty Index and existing NSQIP variables. Logistic regression was performed to acuity adjust the findings.
  
  
  RESULTS
  A total of 58,448 colectomies were identified. As frailty index increased from 0 to 0.55, the proportion of those experiencing Clavien class IV or V complications increased from 3.2% at baseline to 56.3%. Variables found to be significant by logistic regression (odds ratio) were frailty index (14.4; p = 0.001), open procedure (2.35; p < 0.001), and American Society of Anesthesiologists class 4 (3.2; p = 0.038) or 5 (7.1; p = 0.001) while emergency operation and wound classification 3 or 4 were not.
  
  
  CONCLUSIONS
  Complications requiring ICU care represent a significant morbidity in the colectomy patient population. Frailty index seems to be an important predictor of ICU-level complications and death, and laparoscopy seems to be protective.
authors.affiliation: Department of Surgery, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI 48202, USA. nobeid1@hfhs.org
authors.forename: Nadia M
authors.initials: NM
authors.lastname: Obeid
authors.forename: Ogochukwu
authors.initials: O
authors.lastname: Azuh
authors.forename: Subhash
authors.initials: S
authors.lastname: Reddy
authors.forename: Shawn
authors.initials: S
authors.lastname: Webb
authors.forename: Craig
authors.initials: C
authors.lastname: Reickert
authors.forename: Vic
authors.initials: V
authors.lastname: Velanovich
authors.forename: H Mathilda
authors.initials: HM
authors.lastname: Horst
authors.forename: Ilan
authors.initials: I
authors.lastname: Rubinfeld
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003422:Critical Care / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D058996:Quality Improvement / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology