K. Zorbas1, A. Di Carlo1, A. Karachristos1 1Temple University,Department Of Surgery,Philadelpha, PA, USA
Introduction: The aim of the present study was to validate the modified frailty index (mFI) as a preoperative risk predictor for postoperative morbidity and mortality after gastrectomy for a non-bariatric disease.
Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who underwent total or partial gastrectomy for malignancy or benign disease from 2005 to 2011. A modified frailty index was calculated, based on 11 variables: functional status; diabetes mellitus (DM); chronic obstructive pulmonary disease (COPD) or pneumonia; congestive heart failure (CHF); previous myocardial infarction (MI); previous percutaneous coronary intervention (PCI), cardiac surgery, or angina; hypertension (HTN) requiring the use of medications; peripheral vascular disease or rest pain; impaired sensorium; history of transient ischemic attacks (TIA) or cerebrovascular accident without residual deficit; history of cerebrovascular accident with residual deficit. Then the population divided into four categories based on the MFI score. Thirty-day mortality and postoperative complications were evaluated. Chi-square test and logistic regression analyses were performed.
Results: Overall, 6832 patients underwent a gastrectomy for a non-bariatric disease. There were 2320 (36.5%) patients with no frailty, 3309 (52.1%) patient with low frailty (1-2 mFI), 655 (10.3%) with intermediate frailty (3-4 mFI) and 71 (1.1%) frail (≥5 mFI) patients. A higher mFI score is associated with significantly higher rates of mortality (1.5% vs 21.1%, P<0.001), overall morbidity (23.2% vs 66.2%, P<0.001), Clavien IV complications (6.7% vs 46.5%, P<0.001), surgical site infections (12.7% vs 16.9%, P=0.005) and sepsis related complications (9.4% vs 23.9%, P<0.001). Multivariate analysis identified mFI as an independent predictor of Clavien IV complications (OR 5.04, 95%CI 2.79-9.08, P < 0.001) and 30-day mortality (OR 4.63, 95%CI 2.09-10.3, P < 0.001).
Conclusion: An increasing mFI score in patients undergoing a non-bariatric gastrectomy, associated with a higher incidence of morbidity and mortality. MFI Score can be easily calculated preoperatively, from patient’s history, and it can add valuable insight regarding the postoperative mortality and morbidity.
