Frailty in the elderly population is an important predictor of surgical outcomes. It has been quantified by several models, including the modified frailty index, which has demonstrated applicability in many surgical subspecialties. We aim to conduct the first decade-long retrospective analysis of frailty and complications between open and laparoscopic colectomy. We used the American College of Surgeons National Surgical Quality Improvement Program database to identify colectomies performed between 2005 and 2014. Our primary outcome was 30-day mortality. Secondary outcomes were grouped into five categories: wound, hematologic, pulmonary, renal, or cardiac/vascular complications. Chi-square and multivariate logistic regression were used to identify significant predictors of outcomes. Of the 244,639 colectomies identified in our data set, 117,064 cases were included after exclusion criteria were applied. 42,192 (36%) cases were laparoscopic. Mortality rates among open colectomies in mFI cohorts 0, 1, 2, 3, and ≥ 4 were 1.2, 3.4, 7.9, 14.3, and 20.3%, respectively, while rates in laparoscopic colectomies 0.2, 0.7, 2, 3.5, and 5.4%, respectively (p < 0.05). Logistic regression showed increase likelihood of mortality with open colectomies in all mFI cohorts (p < 0.05). The open approach also had statistically significant higher rates of secondary outcomes in nearly all frailty levels. Our study analyzed the relationship of frailty, approach to colectomy, and postoperative complications. Laparoscopic colectomies resulted in lower mortality rates as well as less wound, hematologic, pulmonary, renal, and cardiovascular complications.
Frailty Colectomy Laparoscopic Open
This is a preview of subscription content, log in to check access.
All authors listed above contributed to the manuscript and have met all of the authorship guidelines as per the International Committee of Medical Journal Editors (ICMJE).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no potential conflict of interest.
Research involving human participants and/or animals
Our research was approved and exempted by the Institutional Review Board at Rutgers-New Jersey Medical School.
For this type of study informed consent is not required.
Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I (2013) Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res 183(1):104–110CrossRefGoogle Scholar
Karam J, Tsiouris A, Shepard A, Velanovich V, Rubinfeld I (2013) Simplified frailty index to predict adverse outcomes and mortality in vascular surgery patients. Ann Vasc Surg 27(7):904–908CrossRefGoogle Scholar
Chimukangara M, Frelich MJ, Bosler ME, Rein LE, Szabo A, Gould JC (2016) The impact of frailty on outcomes of paraesophageal hernia repair. J Surg Res 202(2):259–266CrossRefGoogle Scholar
Farhat JS, Velanovich V, Falvo AJ et al (2012) Are the frail destined to fail? Frailty index predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg 72(6):1526–1531CrossRefGoogle Scholar
Langholz E, Munkholm P, Davidsen M, Binder V (1994) Course of ulcerative colitis: analysis of changes in disease activity over years. Gastroenterology 107(1):3–11CrossRefGoogle Scholar
Peery AF, Cools KS, Strassle PD et al (2018) Increasing rates of surgery for patients with non-malignant colorectal polyps in the United States. Gastroenterology S0016–5085(18):30014–30013Google Scholar
Mutch M (2006) Laparoscopic colectomy in the elderly: when is too old? Clin Colon Rectal Surg 19(1):33–39CrossRefGoogle Scholar
Congiusta DV, Palvannan P, Merchant AM (2017) The impact of frailty on morbidity and mortality following open emergent colectomies. BioMed Res IntGoogle Scholar
Bardakcioglu O, Khan A, Aldridge C, Chen J (2013) Growth of laparoscopic colectomy in the United States: analysis of regional and socioeconomic factors over time. Ann Surg 258(2):270–274CrossRefGoogle Scholar
Abraham NS, Byrne CM, Young JM, Solomon MJ (2007) Meta-analysis of non-randomized comparative studies of the short-term outcomes of laparoscopic resection for colorectal cancer. ANZ J Surg 77(7):508–516CrossRefGoogle Scholar
The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
Mosquera C, Spaniolas K, Fitzgerald TL (2016) Impact of frailty on approach to colonic resection: laparoscopy vs open surgery. World J Gastroenterol 22(43):9544–9553CrossRefGoogle Scholar
American College of Surgeons National Surgical Quality Improvement Program (2015) User Guide for the 2014 ACS NSQIP Participant Use Data File (PUF)Google Scholar
Fried LP, Tangen CM, Watson J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156CrossRefGoogle Scholar
Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173(5):489–495CrossRefGoogle Scholar
Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland JC Jr, Moss M (2013) Simple frailty score predicts post-operative complications across surgical specialties. Am J Surg 206(4):544–550CrossRefGoogle Scholar
Saxton A, Velanovich V (2011) Preoperative frailty and quality of life as predictors of postoperative complications. Ann Surg 253(6):1223–1229CrossRefGoogle Scholar
Makary MA, Segev DL, Pronovost PJ et al (2010) Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210(6):901–908CrossRefGoogle Scholar
Numata M, Sawazaki S, Morita J et al (2018) Comparison of laparoscopic and open surgery for colorectal cancer in patients with severe comorbidities. Anticancer Res 38(2):963–967Google Scholar
Bosker RJI, Van’t Riet E, de Noo M, Vermaas M, Karsten TM, Pierie JP (2018) Minimally invasive versus open approach for right-sided colectomy: a study in 12,006 patients from the Dutch surgical colorectal audit. Dig SurgGoogle Scholar
The Colon Cancer Laparoscopic or Open Resection Study Group (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484CrossRefGoogle Scholar
Zoog E, Giles WH, Maxwell RA (2017) An update on the current management of perforated diverticulitis. Am Surg 83(12):1321–1328Google Scholar
Saia M, Buja A, Mantoan D, Agresta F, Baldo V (2016) Colon cancer surgery: a retrospective study based on a large administrative database. Surg Laparosc Endosc Percutan Tech 26(6):e126–e131CrossRefGoogle Scholar
Grosso G, Biondi A, Marventano S, Mistretta A, Calabrese G, Basile F (2012) Major postoperative complications and survival for colon cancer elderly patients. BMC Surg 12(Suppl 1):S20CrossRefGoogle Scholar
Hines RB, Chatla C, Bumpers HL et al (2009) Predictive capacity of three comorbidity indices in estimating mortality after surgery for colon cancer. J Clin Oncol 27(26):4339–4345CrossRefGoogle Scholar
Sammour T, Cohen L, Karunatillake AI et al (2017) Validation of an online risk calculator for the prediction of anastomotic leak after colon cancer surgery and preliminary exploration of artificial intelligence-based analytics. Tech Coloproctol 11:869–877CrossRefGoogle Scholar
Robinson CN, Chen GJ, Balentine CJ et al (2011) Minimally invasive surgery is underutilized for colon cancer. Ann Surg Oncol 18(5):1412–1418CrossRefGoogle Scholar
Catalina M, Konstantinos S, Fitzgerald TL (2016) Impact of frailty on approach to colonic resection: laparoscopy vs open surgery. World J Gastroenterol 22(43):9544–9553CrossRefGoogle Scholar
Simorov A, Shaligram A, Shostrom V, Boilesen E, Thompson JOD (2012) Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers. Ann Surg 256(3):462–468CrossRefGoogle Scholar