eP364 - The 5-Factor Modified Frailty Index Correlates with Adverse Outcomes Following Low Anterior Resection in Rectal Cancer Patients

Purpose/Background: The 5-factor modified frailty index (mFI-5) has previously been shown to predict adverse outcomes in patients following colorectal surgery. The mFI-5 is a concise tool containing variables that are consistently recorded in the NSQIP dataset that is equally predictive of 30-day outcomes as frailty tools with more variables. However, it has not been investigated whether patients who undergo a low anterior resection (LAR) for rectal cancer (RC) are impacted by their mFI-5 score. This study aims to analyze the impact the mFI-5 has on 30-day postoperative events and discharge destination following a LAR for RC.Methods/Interventions: The National Surgical Quality Improvement Program (NSQIP) colectomy targeted database was queried between 2016 and 2020 for patients who underwent an LAR for rectal cancer. The CPT codes used included 44145, 44146, 44207, and 44208. The mFI-5 score is calculated using the following factors: hypertension, congestive heart failure, diabetes, chronic obstructive pulmonary disease, and partially or fully dependent functional status where each was assigned 1 point. Univariate and multivariate logistic regression analysis were used to determine the association between 30-day complications, readmission, and discharge destination with the mFI-5 score.Results/Outcomes: In this study, 9,805 patients with RC who underwent a LAR were analyzed with a mean age of 59.7 years and a BMI of 28.3 kg/m2. Most patients (79%) had a minimally invasive surgery (MIS) approach to their LAR (48% laparoscopic and 31% robotic). Approximately 55.3% had an mFI-5 of 0, 34.5% had an mFI-5 of 1, and 10.1% had an mFI-5 ≥ 2. Nearly 17% of the patients experienced a postoperative complication, 16.6% were readmitted, and 4.4% were discharged to a location other than home. There was a significant increase in complications seen with higher mFI-5 scores (14.4% when mFI-5 = 0, 18.5% when mFI-5 = 1, 25.7% when mFI-5 ≥ 2; p < 0.01), readmission rates (13.7% when mFI-5 = 0, 18.8% when mFI-5 = 1, 24.9% when mFI-5 ≥ 2; p < 0.01), and higher rates of non-home discharge (2.4% when mFI-5 = 0, 5.8% when mFI-5 = 1, 10.5% when mFI-5 ≥ 2; p < 0.01) (Figure). Multivariate logistic regression revealed that mFI-5 ≥ 2 (OR: 1.58, CI: 1.28-1.96, p < 0.01) versus a score of 0 was a predictor of any 30-day postoperative complications. mFI-5 of 1 (OR: 1.36, CI: 1.13-1.58, p < 0.01) and mFI-5 ≥ 2 (OR: 1.87, CI: 1.48-2.38, p < 0.01) were also independent predictors of readmission. Additionally, an mFI-5 = 1 (OR: 1.41, CI: 1.02-1.95, p = 0.04) and ≥ 2 (OR: 2.19, CI: 1.48-3.22, p < 0.01) were predictors of discharge to a location other than home.Conclusion/

Discussion: This retrospective study of the NSQIP database shows that the mFI-5 score is an independent predictor of postoperative complications, readmission, and non-home discharge in RC patients who underwent a LAR. During preoperative counseling regarding increased risk of early postoperative complication, readmission, and non-home disposition, surgeons should acknowledge patient frailty. Optimizing patients preoperatively may be considered as a method to lower this additional risk. Further prospective research needs to be completed to risk stratify patients and create interventions to mitigate risk.Univariate analysis of mFI-5 on complications, readmission rates, and non-home discharge