J. S. Park1, S. B. Bateni1, A. R. Kirane1, R. J. Bold1, D. J. Canter2, R. J. Canter1 2Ocshner Clinic,Urology,New Orleans, LOUSIANA, USA 1University Of California – Davis,Sacramento, CA, USA
Introduction: Preoperative risk assessment is important and critical as the population ages with increasing number of comorbidities. The modified frailty index (mFI) is an important method to risk-stratify surgical patients that has been validated for general surgery and selected surgical subspecialties. However, there are currently no data assessing the efficacy of the mFI to predict acute morbidity and mortality in patients undergoing surgery for retroperitoneal sarcoma (RPS).
Method: Using the American College of Surgeons’ National Surgical Quality Improvement Program from 2007 to 2012, we performed a retrospective analysis of patients identified by ICD-9 and CPT codes with a diagnosis of retroperitoneal neoplasm who underwent surgical resection. We calculated mFI consistent with published methods and patients were categorized as frail when mFI≥0.27. Univariate and multivariate analyses including χ² and logistic regression was utilized to identify predictors of 30-day overall morbidity, Clavien IV/V morbidity and mortality.
Results: We identified 950 patients with the diagnosis of retroperitoneal neoplasm undergoing surgical resection. Tumors were stratified by size ≤5cm (19.7%, n=187), 5–10 cm (17.5%, n=166), and >10cm (62.8%, n=597). The average age was 59 (SD±13) and majority of patients were female (50.6%, n=480) and Caucasian (79.6%, n=755) with independent functional status (97.6%, n=923). Only 36 (4.9%) were classified as frail. Few had undergone preoperative chemotherapy (5.2%, n=38) and radiotherapy (7.2%, n=52). Rates of 30-day overall morbidity, Clavien IV/V morbidity, and mortality were 22.3% (n=212), 6.0% (n=57), and 1.1% (n=10) respectively. Frailty was a significant predictor of Clavien IV/V morbidity on univariate (OR = 4.99, 95%CI = 2.03-12.24, p<0.001) and multivariate (OR 3.16, 95%CI = 1.01-9.87, p<0.01) analysis. As the mFI increased, there was an increase in the Clavien IV/V complications (p<0.01). However, frailty was not a predictor of overall morbidity and mortality (p>0.05). Impaired functional status alone was the significant predictor of mortality on univariate (OR = 32.18, 95%CI = 8.39-123.40, p<0.001) and multivariate analysis (OR = 25.49, 95%CI =2.68-242.78, p<0.01). Tumor size and preoperative chemotherapy or radiotherapy were not associated with 30-day overall and Clavien IV/V morbidity and mortality on univariate analysis with p>0.20 and, therefore, excluded in the multivariate analysis.
Conclusion: Our data demonstrate that the vast majority of patients undergoing RPS resections are healthy with very few frail patients identified. Although frailty was a significant predictor of serious complications, it was not significantly predictive of overall morbidity and mortality. Our findings suggest that impaired preoperative functional status may be of greater utility than mFI to risk-stratify patients undergoing RPS resections.