Association of frailty with outcomes of resection for colonic volvulus: A national analysis

Abstract

Background: With limited national studies available, we characterized the association of frailty with outcomes of surgical resection for colonic volvulus. Methods: Adults with sigmoid or cecal volvulus undergoing non-elective colectomy were identified in the 2010-2019 Nationwide Readmissions Database. Frailty was identified using the Johns Hopkins indicator which utilizes administrative codes. Multivariable models were developed to examine the association of frailty with in-hospital mortality, perioperative complications, stoma use, length of stay, hospitalization costs, non-home discharge, and 30-day non-elective readmissions. Results: An estimated 66,767 patients underwent resection for colonic volvulus (Sigmoid: 39.6%; Cecal: 60.4%). Using the Johns Hopkins indicator, 30.3% of patients with sigmoid volvulus and 15.9% of those with cecal volvulus were considered frail. After adjustment, frail patients had higher risk of mortality compared to non-frail in both sigmoid (10.6% [95% CI 9.47-11.7] vs 5.7% [95% CI 5.2-6.2]) and cecal (10.4% [95% CI 9.2-11.6] vs 3.5% [95% CI 3.2-3.8]) volvulus cohorts. Frailty was associated with greater odds of acute venous thromboembolism occurrences (Sigmoid: AOR 1.50 [95% CI 1.18-1.94]; Cecal: AOR 2.0 [95% CI 1.50- 2.72]), colostomy formation (Sigmoid: AOR 1.73 [95% CI 1.57-1.91]; Cecal: AOR 1.48 [95% CI 1.10-2.00]), non-home discharge (Sigmoid: AOR 1.97 [95% CI 1.77-2.20]; Cecal: AOR 2.56 [95% CI 2.27-2.89]), and 30-day readmission (Sigmoid: AOR 1.15 [95% CI 1.01- 1.30]; Cecal: AOR 1.26 [95% CI 1.10-1.45]). Frailty was associated with incremental increase in length of stay (Sigmoid: +3.4 days [95% CI 2.8-3.9]; Cecal: +3.8 days [95% CI 3.3-4.4]) and costs (Sigmoid: +$7.5k [95% CI 5.9-9.1]; Cecal: +$12.1k [95% CI 10.1- 14.1]). Conclusion: Frailty, measured using a simplified administrative tool, is associated with significantly worse clinical and financial outcomes following non-elective resections for colonic volvulus. Standard assessment of frailty may aid risk-stratification, better inform shared-decision making, and guide healthcare teams in targeted resource allocation in this vulnerable patient population.