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Frailty in inflammatory bowel disease: analysis of the National Inpatient Sample 2015-2019.
- Source :
-
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2024 May; Vol. 26 (5), pp. 958-967. Date of Electronic Publication: 2024 Apr 04. - Publication Year :
- 2024
-
Abstract
- Aim: Preoperative frailty has been associated with adverse postoperative outcomes in various populations, but of its use in patients with inflammatory bowel disease (IBD) remains sparse. The present study aimed to characterize the impact of frailty, as measured by the modified frailty index (mFI), on postoperative clinical and resource utilization outcomes in patients with IBD.<br />Methods: This retrospective population-based cohort study assessed patients from the National Inpatient Sample database from 1 September 2015 to 31 December 2019. Corresponding International Classification of Diseases 10th Revision Clinical Modification codes were used to identify adult patients (>18 years of age) with IBD, undergoing either small bowel resection, colectomy or proctectomy. Patient demographics and institutional data were collected for each patient to calculate the 11-point mFI. Patients were categorized as either frail or robust using a cut-off of 0.27. Primary outcomes were postoperative in-hospital morbidity and mortality, whilst secondary outcomes included system-specific morbidity, length of stay, in-hospital healthcare costs and discharge disposition. Logistic and linear regression models were used for primary and secondary outcomes.<br />Results: Overall, 7144 patients with IBD undergoing small bowel resection, colectomy or proctectomy were identified, 337 of whom were classified as frail (i.e., mFI < 0.27). Frail patients were more likely to be women, older, have lower income and a greater number of comorbidities. After adjusting for relevant covariates, frail patients were at greater odds of in-hospital mortality (adjusted odds ratio [aOR] 5.42, 95% CI 2.31-12.77, P < 0.001), overall morbidity (aOR 1.72, 95% CI 1.30-2.28, P < 0.001), increased length of stay (adjusted mean difference 1.3 days, 95% CI 0.09-2.50, P = 0.035) and less likely to be discharged to home (aOR 0.59, 95% CI 0.45-0.77, P < 0.001) compared to their robust counterparts.<br />Conclusions: Frail IBD patients are at greater risk of postoperative mortality and morbidity, and reduced likelihood of discharge to home, following surgery. This has implications for clinicians designing care pathways for IBD patients following surgery.<br /> (© 2024 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)
- Subjects :
- Humans
Male
Female
Retrospective Studies
Middle Aged
Adult
Aged
United States epidemiology
Inpatients statistics & numerical data
Hospital Mortality
Databases, Factual
Intestine, Small surgery
Inflammatory Bowel Diseases surgery
Inflammatory Bowel Diseases complications
Frailty complications
Frailty epidemiology
Colectomy statistics & numerical data
Postoperative Complications epidemiology
Postoperative Complications etiology
Length of Stay statistics & numerical data
Proctectomy statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1463-1318
- Volume :
- 26
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
- Publication Type :
- Academic Journal
- Accession number :
- 38576076
- Full Text :
- https://doi.org/10.1111/codi.16967