title: Impact of frailty on approach to colonic resection: Laparoscopyvsopen surgery.
abstract: OBJECTIVE
  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 ± 15.31vs60.55 ± 14.93) and had a higher ASA score (48.3% ASA3vs57.7% ASA2 in the LC group) (P< 0.0001). Most patients were non-frail (42.5% OCvs48% 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Catalina
authors.initials: C
authors.lastname: Mosquera
authors.affiliation: 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.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
authors.affiliation: 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.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Fitzgerald
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Colectomy; Frailty; Morbidity; Mortality; Outcome