Frailty Assessment Predicts Acute Outcomes in Patients Undergoing Screening Colonoscopy
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Colonoscopy is associated with multiple adverse outcomes. With an aging population undergoing colorectal cancer screening, few modalities exist to assess the patient risk prior to colonoscopy. Frailty, the age-related decline in reserve and function across multiple organ systems, predicts poor surgical outcomes, but its role in endoscopy is unclear.
This prospective cohort study assesses the efficacy of frailty in predicting acute colonoscopy outcomes.
Participants aged ≥ 50 years undergoing screening colonoscopy at a tertiary care center were recruited over 2 months ending in July 2017. Frailty was assessed using a validated 20-s upper-extremity frailty test, which measures the capacity of muscle performance. Demographic data, American Society of Anesthesiologists (ASA) status, and Charlson comorbidity index (CCI) were evaluated. Procedure-related adverse events and cardiopulmonary changes during and in the immediate post-procedure period were recorded. Adverse events were stratified into minor and major events. Chi-square and ANCOVA models were used in the analysis.
Ninety-nine adults (mean age 62.8 years) were enrolled, among which 49 were non-frail and 50 were pre-frail/frail; 50 were female. Overall, 55 participants experienced a total of 87 adverse events. Frailty and ASA status were significantly associated with colonoscopy adverse events (p = 0.01 and p = 0.02, respectively). Age and CCI did not predict colonoscopy outcomes.
Compared to age and CCI, frailty status better predicts colonoscopy outcomes in older adults. Among adults undergoing colonoscopy, routine frailty screening should be considered for risk stratification. Additional prospective studies evaluating frailty measurements in endoscopy will further clarify its role in forecasting adverse events.
KeywordsFrailty Colonoscopy Outcomes Screening Older Comorbidity ASA Age
We want to thank Marilyn Gilbert for help coordinating the study.
ST and NT contributed to the design of the study, drafted the study, provided final approval for publication, and agreed to be held accountable for all aspects of the work. SJ, TG, SG, RW, and CT contributed to gathering data for the study, provided critical revision of the study for important content, provided final approval for publication, and agreed to be held accountable for all aspects of the work. JM contributed to the design of the study, provided critical revision of the study for important content, provided final approval for publication, and agreed to be held accountable for all aspects of the work.
University of Arizona, Department of Medicine, Pilot funding
Compliance with ethical standards
Conflict of interest
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