Thompson Dakota T, Breyfogle Ethan G, Tran Catherine G, Suraju Mohammed O, Mishra Aditi, Lanewalla Hussain A, Goffredo Paolo, Hassan Imran
Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America.
Aga Khan University, Karachi, Pakistan.
Surg Open Sci. 2024 Mar 28;19:95-100. doi: 10.1016/j.sopen.2024.03.011. eCollection 2024 Jun.
Frailty has been associated with worse postoperative outcomes. The 5-factor modified frailty index (mFI-5) is an objective measure although its validity in measuring frailty in patients undergoing ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) has not been reported.
This study used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted proctectomy database. The mFI-5 was calculated by five preoperative diagnoses: insulin-dependent or noninsulin-dependent diabetes, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and dependent or partially dependent functional status. The impact of mFI-5 on minor and major postoperative morbidity in CUC patients undergoing IPAA was analyzed.
The cohort included 1454 patients (median age 38 years, median body mass index [BMI] 26 kg/m2) of which 87 % had a mFI-5 = 0, 11 % had a mFI-5 = 1, and 2.5 % a mFI-5 ≥ 2. In multivariable logistic regression, mFI-5 ≥ 2 was significantly associated with minor complications (OR = 2.29, 95 % CI [1.00-5.22], = 0.049), but not with major complications ( = 0.860).
IPAA for CUC is associated with high postoperative morbidity, however, the mFI-5 alone has limited utility in determining which patients are at a higher risk of complications due to frailty. These observations suggest there is a need for more relevant instruments to measure frailty in this patient cohort.
衰弱与术后不良结局相关。五因素改良衰弱指数（mFI-5）是一种客观指标，但其在测量慢性溃疡性结肠炎（CUC）患者行回肠储袋肛管吻合术（IPAA）时衰弱情况的有效性尚未见报道。
本研究使用了美国外科医师学会国家外科质量改进计划（ACS-NSQIP）的针对性直肠切除术数据库。mFI-5通过术前五项诊断计算得出：胰岛素依赖型或非胰岛素依赖型糖尿病、充血性心力衰竭、高血压、慢性阻塞性肺疾病以及依赖或部分依赖的功能状态。分析了mFI-5对接受IPAA的CUC患者术后轻微和严重并发症的影响。
该队列包括1454例患者（中位年龄38岁，中位体重指数[BMI]26kg/m²），其中87%的患者mFI-5 = 0，11%的患者mFI-5 = 1，2.5%的患者mFI-5≥2。在多变量逻辑回归分析中，mFI-5≥2与轻微并发症显著相关（OR = 2.29，95%CI[1.00 - 5.22]，P = 0.049），但与严重并发症无关（P = 0.860）。
CUC患者行IPAA术后并发症发生率较高，然而，单独使用mFI-5在确定哪些患者因衰弱而发生并发症的风险较高方面效用有限。这些观察结果表明，需要更相关的工具来测量该患者队列中的衰弱情况。
