Will My Patient Survive an Anastomotic Leak? Predicting Failure to Rescue Using the Modified Frailty Index
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ORIGINAL ARTICLE – COLORECTAL CANCER
Will My Patient Survive an Anastomotic Leak? Predicting Failure to Rescue Using the Modified Frailty Index Richard T. Spence, MD, MPH, PhD, FCS(SA)1 , Dhruvin H. Hirpara, MD1, Sachin Doshi, MD, MEng2, Fayez A. Quereshy, MD, MBA, FRCSC, FACS1,2,3, and Sami A. Chadi, MD, MSc, FRCSC, FACS1,2,3 1
Department of Surgery, University of Toronto, Toronto, Canada; 2Faculty of Medicine, University of Toronto, Toronto, Canada; 3University Health Network and Princess Margaret Hospital, Toronto, ON, Canada
ABSTRACT Importance. Failure to rescue (FTR), or death after major complications, has emerged as a marker of hospital-level quality of care. Objective. To evaluate the predictive performance of the ACS-NSQIP modified frailty index (mFI) in determining FTR following an anastomotic leak (AL) after a colectomy for colorectal cancer. Design. Retrospective cohort study. Setting. Multicenter interrogation of the 2012–2016 American College of Surgeons (ACS) colectomy procedure targeted National Surgical Quality Improvement Program (NSQIP) database. Patients and Methods. A total of 50,944 patients who underwent colectomy for colorectal cancer. Exposure. Frailty as measured by: (1) Age, ASA, and emergency status (model 1), (2) Age, ASA, emergency status, and mFI (model 2), (3) ACS-NSQIP mortality prediction (model 3). Main Outcome and Measure. Primary outcome was FTR after AL. Results. A total of 1755 patients experienced an AL (3.46%) with a FTR rate of 6.44%. The mean age was 65.6 years (95% CI 65.28–65.58 years), median ASA was 3 (IQR 2–3), 51 patients (2.92%) were partially or totally dependent, 366 (20.86%) were diabetic, 105 (5.98%) had a history of chronic obstructive pulmonary disease (COPD),
Society of Surgical Oncology 2020 First Received: 17 June 2020 Accepted: 16 September 2020 S. A. Chadi, MD, MSc, FRCSC, FACS e-mail: [email protected]
32 (1.82%) had a history of congestive heart disease (CHD), and 966 (55.04%) were on hypertensive treatment. The performance of model 1 (AUROC 0.77; 95% CI 0.72–0.81), model 2 (AUROC 0.77; 95% CI 0.73–0.82), and model 3 (AUROC 0.79; 95% CI 0.75–0.83) to predict FTR was not different (p = 0.44). Conclusions and Relevance. Age and ASA remain the most reliable predictors of failure to rescue anastomotic leak after colectomy for colorectal cancer. Addition of the modified frailty index, or all variables collected by NSQIP, did not significantly improve predictive performance.
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Question Can the ACS-NSQIP modified frailty index (mFI) reliably predict failure to rescue (FTR) following an anastomotic leak (AL)? Findings In 50,944 patients who underwent colectomy for colorectal cancer during the study period (FTR 1.41%), 1755 patients experienced an AL (3.46%), with a FTR rate of 6.44%. The predictive performance of a model using age, ASA, and emergency status to predict FTR after AL (model 1), age, ASA, emergency status, and mFI (model 2), as well as the ACS-NSQIP mortality prediction using all variables collected (model 3) was not diff
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