S. Vermillion2, F. Hsu3, R. Dorrell2, C. Clark1 1Wake Forest Baptist Health,Department Of Surgery,Winston Salem, NORTH CAROLINA, USA 2Wake Forest University School Of Medicine,Winston Salem, NORTH CAROLINA, USA 3Wake Forest University School Of Medicine,Public Health Sciences,Winston Salem, NC, USA
Introduction:
Frailty disproportionately impacts older patients with gastrointestinal cancer, rendering these patients at increased risk for poor outcomes following surgery. A frailty index may aid physicians in preoperative risk stratification. We hypothesized that high modified frailty index (mFI) scores are associated with adverse clinical outcomes after tumor resection in older, gastrointestinal cancer patients.
Methods:
All patients (over 60 years) who underwent tumor resection of the liver and bile duct, pancreas, colon and rectum, esophagus, or stomach were identified in the 2005-2012 NSQIP Participant Use File. Patients who were categorized as ASA 5, diagnosed with preoperative sepsis, or underwent emergency procedures were excluded. mFI was defined by 11 previously described, preoperative variables. Frailty was defined by an mFI score > 0.27. The postoperative course was evaluated using univariate and multivariate analysis.
Results:
41,455 patients (mean age 72.4 years, 47.4% female) met the eligibility criteria. Within the study population, the most prevalent form of cancer was colorectal (68.3%, n=28,708), the mean mFI score was 0.11, and 2.8% of patients had a mFI > 0.27 (n=1,164). Patients with high mFI (>0.27) were significantly more likely to have increased length of stay (12.3 vs 9.0 days), major complications (13.9 vs. 10.5%), and 30-day mortality (5.5 vs. 2.5%), (all p<0.001). Univariate analysis revealed that mFI was associated with significantly increased major complications (OR 1.88, 95% CI 1.75-2.02, p<0.001) and 30-day mortality (OR 2.35, 95% CI 2.03-2.72, p<0.001). After adjusting for age, gender, BMI, ASA, albumin level, mFI was identified as an independent predictor of major complications (OR 1.52, 95% CI 1.39-1.65, p< 0.001) and 30-day mortality (OR 1.48, 95% CI 1.24-1.75, p< 0.001).
Conclusion:
mFI was found to be associated with the incidence of postoperative complications and mortality in older surgical patients with gastrointestinal cancer. mFI serves as a useful tool for preoperative risk stratification in this vulnerable population.