Predicting loss of independence after high-risk gastrointestinal abdominal surgery: Frailty vs. NSQIP risk calculator.

Document Type


Publication Date



Surgery, Oncology

Journal Title

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

MeSH Headings

Obesity, Morbid, Pancreatectomy, Digestive System Surgical Procedures, Multivariate Analysis


BACKGROUND: Loss of independence (LOI) is a significant concern for patients undergoing high-risk abdominal surgery. Although the risk for morbidity and mortality has been well studied, there is a dearth of data on risk for LOI.

METHODS: This study utilized NSQIP data from 2015 to 2018 in a retrospective cohort study of patients undergoing high-risk gastrointestinal surgery (e.g. gastric, colorectal, liver, and pancreatic).

RESULTS: The study included 229,573 patients who were preoperatively functionally independent. Of those, 5.3% experienced LOI. The median age for LOI patients was 74 (CI: 67-81), and 56% were female. The most common race was white (n = 9585), followed by African-American (n = 1223) and other (n = 369). The most common GI procedure was colorectal (65%), followed by the pancreas (23%), liver (8.2%), and gastric (3%). On univariate analysis, age, sex, BMI, race, frailty, and pancreatectomy were associated with LOI. On multivariate analysis age (≥85, OR 18.3 CI:16.9-19.9 p < 0.001), female sex (OR 1.24CI: 1.19-1.29 p < 0.001), BMI40 (OR 1.43 CI:1.31-1.56 p < 0.001), African American race (OR 1.20 CI:1.12-1.28 p < 0.001), smoking (OR 1.21 CI:1.14-1.28 p < 0.001), frailty (MFI-5 > 2, OR 4.47 CI:2.63-7.31 p < 0.001), and pancreatectomy (OR 1.86 CI:1.74-1.98 p < 0.001) continued to be associated with LOI. To better define a predictive model, the NSQIP risk calculator was compared to the modified frailty index-5. AUC was 0.80 (CI: 0.797-0.805) and 0.76 (0.760-0.769), respectively.

CONCLUSION: LOI occurs in over five percent of patients undergoing high-risk abdominal surgery. LOI occurs more commonly after pancreatectomy or for those who are frail, underweight, or morbidly obese. Both frailty and the NSQIP risk calculator models similarly predicted LOI.




Laura Nicolais- Resident

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