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Using Modified Frailty Index to Predict Safe Discharge Within 48 Hours of Ileostomy Closure

Wen, Yuxiang M.D.; Jabir, Murad A. M.D.; Dosokey, Eslam M. G. M.D.; Choi, Dongjin M.D.; Petro, Clayton C. M.D.; Brady, Justin T. M.D.; Steele, Scott R. M.D.; Delaney, Conor P. M.D., Ph.D.

Diseases of the Colon & Rectum: January 2017 - Volume 60 - Issue 1 - p 76–80
doi: 10.1097/DCR.0000000000000722
Original Contributions: Benign

BACKGROUND: Enhanced recovery pathways allow for safe discharge and optimal outcomes within 48 hours after ileostomy closure. Unfortunately, some patients undergoing ileostomy closure have prolonged hospital stays. We have shown previously that the Modified Frailty Index can help predict patients who will fail early discharge after laparoscopic colorectal surgery.

OBJECTIVE: The purpose of this study was to use the Modified Frailty Index to identify patients who were safe for early discharge after ileostomy closure.

DESIGN: This was a retrospective review.

SETTINGS: The study was conducted at a tertiary referral center.

PATIENTS: Patients who underwent ileostomy closure (2006–2015) were stratified into early (≤48 hours) and late discharge groups.

MAIN OUTCOME MEASURES: The Modified Frailty Index, morbidity, and readmission rates were measured.

RESULTS: A total of 272 patients undergoing ileostomy closure were evaluated. Overall length of stay was 3.64 days (±3.23 days), with 114 patients (42%) discharged within 48 hours. Sex, age, and ASA scores were similar between early and later discharge groups (p > 0.2). Univariate logistic regression demonstrated that a Modified Frailty Index score of 0 was associated with early discharge (p = 0.03), whereas a Modified Frailty Index score ≤1 and ≤2 were not. There was no significant association between the Modified Frailty Index and complication or readmission rates. Postoperative complications occurred in 39 patients (14.3%), and 1 patient died secondary to an anastomotic leak. Fifteen patients (5.5%) were readmitted within 30 days. Readmission rate within 30 days was 3.2%, with a Modified Frailty Index score of 0, 6.1% for a Modified Frailty Index score of <1, and 5.9% for a Modified Frailty Index score of <2, for which there was not an association based on univariate logistic regression (Modified Frailty Index = 0, p = 0.13; <1, p = 0.55; <2, p = 0.53).

LIMITATIONS: The study was limited by nature of being a retrospective review.

CONCLUSIONS: Patients undergoing ileostomy closure with a Modified Frailty Index score of 0 are associated with higher rates of discharge within 48 hours of ileostomy closure surgery than those with a higher Modified Frailty Index, without higher readmission rates. This information can be helpful to better manage patient and resource use expectations for the duration of inpatient recovery.

1 Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio

2 Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

3 Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio

Financial Disclosure: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Los Angeles, CA, April 30 to May 4, 2016.

Correspondence: Justin T. Brady, M.D., University Hospitals Case Medical Center, 11100 Euclid Ave, Department of Surgery, Cleveland, OH 44106. E-mail:

© 2017 The American Society of Colon and Rectal Surgeons