The Predictive Impact of Frailty Index on Outcomes Following Emergency Colectomy for Obstructing and Perforated Colon Cancer

This study aimed to analyze the predictive impact of frailty index and patterns of outcomes in patients with obstructing and perforated colon cancer who had emergency surgery. The nighty-nine patients who underwent right and left hemicolectomy were retrospectively evaluated within emergency conditions such as obstruction or perforation of tumor between February 2017 and October 2020. The 5-mFI (modified frailty index) score was measured by multiplying each number of frailty features (1 point per each existence; 0 - 5 points) and categorized into three groups (mFI=0, mFI=1, and mFI ≥ 2). The average age of the patient population was 65.21±13.84 years old. The male patients were 60 (60%). Albumin level was seen lower in patients who had higher mFI (3.86±0.63vs. 3.51±0.76 vs. 3.51±0.65, p=0.045). The predictive outcomes regarding the mFI potentially showed increased Clavien Dindo classification (CDC) [OR: 1.49, 95%CI: 0.82-2.75, p=0.2], morbidity [OR: 2.43, 95%CI: 0.50-13.98, p=0.3], and leakage [OR: 2.02, 95%CI: 0.63-6.65, p=0.2]. The morbidity (16, 24.6% vs. 16, 47.1%), p=0.041) and mortality (10, 15.4% vs. 9, 26.5%, p=0.289) were more likely seen for right sided tumors. Stoma formation was seen more likely for left sided tumors (29, 60% vs. 8, 23.5%, p=0.001). The 5-mFI score might be assumed as a preoperative prognostic tool for emergency colon surgery considering morbidity, mortality, prolonged hospitalization, and reoperation. Although morbidity and mortality in right-sided tumors and stoma formation are higher in left-sided tumors, 5-mFI score can be evaluated in patients regardless of colon cancer location.