Journal of Gastrointestinal Surgery

, Volume 22, Issue 4, pp 640–649 | Cite as

The Effect of Frailty Index on Early Outcomes after Combined Colorectal and Liver Resections

  • Sophia Y. Chen
  • Miloslawa Stem
  • Marcelo Cerullo
  • Susan L. Gearhart
  • Bashar Safar
  • Sandy H. Fang
  • Matthew J. Weiss
  • Jin He
  • Jonathan E. Efron
Original Article



Although previous studies have examined frailty as a potential predictor of adverse surgical outcomes, little is reported on its application. We sought to assess the impact of the 5-item modified frailty index (mFI) on morbidity in patients undergoing combined colorectal and liver resections.


Adult patients who underwent combined colorectal and liver resections were identified using the ACS-NSQIP database (2005–2015). The 5-item mFI consists of history of chronic obstructive pulmonary disease, congestive heart failure, hypertension, diabetes, and partial/total dependence. Patients were stratified into three groups: mFI 0, 1, or ≥ 2. The impact of the mFI on primary outcomes (30-day overall and serious morbidity) was assessed using multivariable logistic regression. Subgroup analyses by age and hepatectomy type was also performed.


A total of 1928 patients were identified: 55.1% with mFI = 0, 33.2% with mFI = 1, and 11.7% with mFI ≥ 2. 75.9% of patients underwent wedge resection/segmentectomy (84.6% colon, 15.4% rectum), and 24.1% underwent hemihepatectomy (88.8% colon, 11.2% rectum). On unadjusted analysis, patients with mFI ≥ 2 had significantly greater rates of overall and serious morbidity, regardless of age and hepatectomy type. These findings were consistent with the multivariable analysis, where patients with mFI ≥ 2 had increased odds of overall morbidity (OR 1.41, 95% CI 1.02–1.96, p = 0.037) and were more than twice likely to experience serious morbidity (OR 2.12, 95% CI 1.47–3.04, p < 0.001).


The 5-item mFI is significantly associated with 30-day morbidity in patients undergoing combined colorectal and liver resections. It is a tool that can guide surgeons preoperatively in assessing morbidity risk in patients undergoing concomitant resections.


Frailty index Synchronous colorectal liver metastasis Morbidity Mortality 



Sophia Y. Chen received financial support from the Johns Hopkins Institute for Clinical and Translational Research (ICTR), funded in part by Grant TL1 TR001078 from the National Center for Advancing Translational Sciences (NCATS). The contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH.

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding Source

Sophia Y. Chen: Grant Number TL1 TR001078

Author Contributions

Study design: S.Y.C., M.S., J.E.E.

Data acquisition and analysis: S.Y.C., M.S., J.E.E.

Interpretation of data: S.Y.C., M.S., M.C., S.L.G., B.S., S.H.F., M.J.W., J.H., J.E.E.

Drafting work: S.Y.C., M.S., M.C., J.E.E.

Critical revision: S.Y.C., M.S., M.C., S.L.G., B.S., S.H.F., M.J.W., J.H., J.E.E.

Final approval and accountability: S.Y.C., M.S., M.C., S.L.G., B.S., S.H.F., M.J.W., J.H., J.E.E.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Sophia Y. Chen
    • 1
  • Miloslawa Stem
    • 1
  • Marcelo Cerullo
    • 1
  • Susan L. Gearhart
    • 1
  • Bashar Safar
    • 1
  • Sandy H. Fang
    • 1
  • Matthew J. Weiss
    • 1
  • Jin He
    • 1
  • Jonathan E. Efron
    • 1
  1. 1.Department of SurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA

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