The composite risk index based on frailty predicts postoperative complications in older patients recovering from elective digestive tract surgery: a retrospective cohort study

Table 4 Postoperative outcomes according to modified frailty index and composite risk index

	Modified frailty index		P value	Composite risk index ^a			P value
	< 0.27 (n = 698)	≥0.27 (n = 225)	P value	0 (n = 502)	1 (n = 306)	≥2 (n = 115)	P value
Postoperative complications ^b	161 (23.1%)	96 (42.7%)	< 0.001	89 (17.7%)	110 (35.9%)^*	58 (50.4%)^*†	< 0.001
Clavien-Dindo classification ^c
Grade III or higher complications	57 (8.2%)	40 (17.8%)	< 0.001	24 (4.8%)	36 (11.8%)^*	37 (32.2%)^*†	< 0.001
Grade IV or higer complications	36 (5.2%)	28 (12.4%)	< 0.001	15 (3.0%)	20 (6.5%)^*	29 (25.2%)^*†	< 0.001
Grade V complications	4 (0.6%)	3 (1.3%)	0.483	2 (0.4%)	0 (0.0%)	5 (4.3%)^*†	< 0.001
ICU admission	129 (18.5%)	107 (47.6%)	< 0.001	74 (14.7%)	101 (33.0%)^*	61 (53.0%)^*†	< 0.001
LOS in ICU, hour ^d	21.0 (17.0, 39.0)	28.0 (19.0, 71.0)	0.018	20.0 (17.0, 32.5)	24.0 (18.0, 56.5)	32.0 (20.5, 96.0)^*†	< 0.001
Unplanned reintubation	6 (0.9%)	6 (2.7%)	0.081	4 (0.8%)	3 (1.0%)	5 (4.3%)^*	0.027
Unplanned reoperation	21 (3.0%)	7 (3.1%)	0.938	14 (2.8%)	13 (4.2%)	1 (0.9%)	0.197
Hospital LOS, day	16.0 (13.0, 20.0)	19.0 (15.0, 26.0)	< 0.001	16.0 (12.8, 19.0)	18.0 (15.0, 24.0) ^*	21.0 (16.0, 27.0) ^*†	< 0.001
Hospital LOS after surgery, day	9.0 (8.0, 12.0)	10.0 (8.0, 13.0)	0.002	9.0 (7.0, 11.0)	10.0 (8.0, 13.0)^*	11.0 (9.0, 14.0)^*	< 0.001
Adverse discharge destination ^e	8 (1.1%)	7 (3.1%)	0.085	6 (1.2%)	6 (2.0%)	3 (2.6%)	0.399

Data are n (%) or median (interquartile range). P values in bold indicate < 0.05. ^*P < 0.05/3 = 0.017 (Bonferroni-corrected post hoc multiple comparisons) when compared with the patients with a composite risk index of 0. ^†P < 0.017 when compared with the patients with a composite risk index of 1
ICU intensive care unit, LOS length of stay
^a A composite of four items, i.e., modified frailty index ≥0.27, malnutrition [33], moderate or severe anemia (hemoglobin < 90 g/L), and severe hypoalbuminemia (albumin ≤30 g/L). Each item was assigned the same weight of 1 point
^b Indicate those of Clavien-Dindo grade II or higher. Also see Supplementary Table 4
^c Clavien-Dindo classification of postoperative complications [35]
^d Results of patients who were admitted to the ICU
^e Defined as discharge to destinations other than home (e.g., a long- or short-term care facility)

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