Frailty tied to worse outcomes after surgery for colonic volvulus

In patients who had undergone nonelective resection for colonic volvulus, frailty appears to worsen clinical outcomes, according to a recent study. Screening for frailty could help improve risk stratification and guide healthcare decision making.

“Simple frailty assessments preoperatively may inform expectations, identify high-risk patients, and guide healthcare systems in targeted resource allocation to optimize outcomes in this vulnerable patient population,” the researchers said.

The study included 66,767 patients undergoing surgery for colonic volvulus. Frailty was present in 30.3 percent of patients with sigmoid volvulus and in 15.9 percent of those with caecal volvulus, as assessed by the Johns Hopkins instrument. Dementia and malnutrition were the most common frailty-associated clusters among patients. [PLoS One 2022;doi:10.1371/journal.pone.0276917]

Moreover, frail participants were older and had a higher comorbidity burden than nonfrail comparators. They were also more likely to be in the lowest income quartile. These were true for both sigmoid and caecal volvulus subgroups.

Researchers conducted outcome analyses separately for the two different volvulus subgroups. They found that in the case of sigmoid volvulus, prevalence increased from 26.6 percent in 2010 to 31.4 percent in 2019 (p_trend=0.007). Over the same time span, in-hospital mortality rates in frail participants dropped significantly but remained higher in nonfrail comparators.

Multivariate regression analysis confirmed that frailty was a significant risk factor for in-hospital mortality, increasing such likelihood by more than 30 percent (adjusted odds ratio [OR], 1.31, 95 percent confidence interval [CI], 1.09–1.56).

Similarly, frailty aggravated the risks of postoperative infections (adjusted OR, 1.30, 95 percent CI, 1.02–1.67), venous thromboembolism (adjusted OR, 1.50, 95 percent CI, 1.18–1.94), and colostomy (adjusted OR, 1.73, 95 percent CI, 1.57–1.91).

Frail patients were also more likely to get readmitted within 30 days for nonelective reasons (adjusted OR, 1.15, 95 percent CI, 1.01–1.30) and have significantly longer length of stay (β, 3.4, 95 percent CI, 2.8–3.9) and have higher index hospitalization costs (β, 7.5, 95 percent CI, 5.9–9.1).

Researchers observed similar effects of frailty on those with caecal volvulus. Patients who were frail saw an approximately 50-percent jump in the likelihood of in-hospital mortality (adjusted OR, 1.51, 95 percent CI, 1.24–1.85) and colostomy (adjusted OR, 1.48, 95 percent CI, 1.10–2.00).

Concurrently, the risks of venous thromboembolism (adjusted OR, 2.0, 95 percent CI, 1.50–2.72) and ileostomy (adjusted OR, 1.94, 95 percent CI, 1.63–2.29) were nearly doubled in frail patients. Frailty likewise led to significantly worse postoperative infections, 30-day nonelective readmissions, length of hospital stay, and costs incurred.

“Frailty was associated with a near doubling in the risk of in-hospital mortality among both sigmoid and caecal volvulus cohorts,” the researchers said, pointing out that frail participants were also “at increased odds of stoma formation, nonhome discharge, and 30-day nonelective readmission, as well as longer risk-adjusted length of stay and greater hospitalization costs.”