Drohat Philip, Hernandez Alexandra E, Reyes Ana M, Kodia Karishma, Caplan Chelsea, Arcieri Talia R, Khalafi Shayan, Meece Matthew S, Hui Vanessa W
Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
J Clin Med. 2025 Aug 24;14(17):5985. doi: 10.3390/jcm14175985.
: Colorectal surgeons continue to care for an aging cancer population with increasing comorbidities and frailty. Frailty, characterized by a systemic physiologic decline associated with aging, is an increasingly popular focus in surgical outcomes research. This retrospective study investigates how frailty impacts outcomes in the octogenarian and nonagenarian populations undergoing surgical treatment for colon cancer. : Data from the National Surgical Quality Improvement Program (NSQIP) colectomy-targeted variables dataset from 2015 to 2021 were utilized for this analysis, including patients 80 years of age and older. Frailty was assessed using the five-factor modified frailty index (mFI-5). The study examined post-operative outcomes across frailty groups in this population. : From 2015-2021, there were 10,671 patients aged 80 years and older who underwent colectomy for colon cancer, of whom 1259 (11.8%) were 90 years or older and 2844 (26.7%) were severely frail. Frailty significantly impacted post-operative colectomy outcomes in this population. On univariate analysis, frail patients had higher rates of pneumonia ( = 0.015), unplanned intubation ( = 0.012), stroke ( < 0.001), myocardial infarction ( = 0.011), readmission ( < 0.001), long length of stay ( < 0.001), and mortality ( < 0.001) compared to non-frail patients. On multivariate analysis, severe frailty (mFI-5 of 2 or more) was associated with an increased odds of unplanned intubation (aOR 2.41, 95% CI 1.27-4.59), long length of stay (aOR 1.73, 95% CI 1.44-2.09), readmission (aOR 1.84, 95% CI 1.42-2.39), and mortality (aOR 1.95, 95% CI 1.20-3.15) compared to non-frail patients. : Frailty plays a critical role in influencing the outcomes of octogenarians and nonagenarians undergoing colectomy for colon cancer within the NSQIP dataset. Future work should investigate whether addressing frailty prior to surgery in this population can improve patients' post-operative courses.
结直肠外科医生继续为合并症和身体虚弱情况日益增加的老年癌症患者提供治疗。身体虚弱以与衰老相关的全身性生理衰退为特征，是外科手术结果研究中一个越来越受关注的焦点。这项回顾性研究调查了身体虚弱如何影响接受结肠癌手术治疗的八九十岁患者的手术结果。
利用2015年至2021年国家外科质量改进计划（NSQIP）以结肠切除术为目标的变量数据集的数据进行分析，包括80岁及以上的患者。使用五因素改良虚弱指数（mFI - 5）评估身体虚弱情况。该研究考察了这一人群中不同虚弱组的术后结果。
2015年至2021年期间，有10671名80岁及以上的患者接受了结肠癌结肠切除术，其中1259名（11.8%）年龄在90岁及以上，2844名（26.7%）身体严重虚弱。身体虚弱对这一人群的结肠切除术后结果有显著影响。单因素分析显示，与非虚弱患者相比，虚弱患者发生肺炎的几率更高（P = 0.015）、非计划插管几率更高（P = 0.012）、中风几率更高（P < 0.001）、心肌梗死几率更高（P = 0.011）、再次入院几率更高（P < 0.001）、住院时间更长（P < 0.001）以及死亡率更高（P < 0.001）。多因素分析显示，与非虚弱患者相比，严重虚弱（mFI - 5为2或更高）与非计划插管几率增加相关（调整后比值比[aOR] 2.41，95%置信区间[CI] 1.27 - 4.59）、住院时间更长（aOR 1.73，95% CI 1.44 - 2.09）、再次入院几率增加（aOR 1.84，95% CI 1.42 - 2.39）以及死亡率增加（aOR 1.95，95% CI 1.20 - 3.15）。
在NSQIP数据集中，身体虚弱在影响八九十岁接受结肠癌结肠切除术患者的手术结果方面起着关键作用。未来的工作应调查在这一人群中术前解决身体虚弱问题是否能改善患者的术后病程。
