BACKGROUND: Frailty has yet to be explored as a risk factor for thoracic surgery. We hypothesized that our modified frailty index (mFI) may be a predictor of morbidity and mortality following lobectomy. MATERIALS: National Surgical Quality Improvement Program (NSQIP) participant use files were reviewed (2005-2010). Patients undergoing lobectomy were identified based on Current Procedural Terminology code 32480. We used an mFI with 11 variables, based on mapping the Canadian Study of Health and Aging Frailty Index to the NSQIP comorbidities. Data were analyzed using χ(2) test, independent sample t-test, Jonckheere-Terpstra test, and logistic regression. RESULTS: Of 1940 open lobectomy patients identified, morbidity and mortality uniformly increased as the mFI increased; 14.9% of patients (75/504) with mFI of 0 had at least one complication, compared with 32% of patients (91/284) with mFI of 0.27 (P < 0.001). An mFI of 0 was associated with a mortality rate of 1% (5/504), compared with 5.6% (16/284) for mFI of 0.27 (P < 0001). Failure to wean from the ventilator, reintubation, surgical site infections, pneumonia, and Clavien 4 and above complications occurred in 1.8% (9/504), 2.6% (13/504), 2.2% (11/504), 5.4% (27/504), and 4.2% (21/504), respectively, in patients with an mFI of 0, compared with 7.4% (21/284), 7% (22/284), 3.2% (9/284), 10.9% (31/284), and 14.4% (41/284), respectively, in patients with mFI of 0.27. CONCLUSIONS: This study demonstrates that the mFI may identify patients at higher risk for morbidity and mortality post-lobectomy. With the aging population, preoperative selection is important in minimizing morbidity and mortality and improving risk stratification for informed decision-making.
BACKGROUND: Frailty has yet to be explored as a risk factor for thoracic surgery. We hypothesized that our modified frailty index (mFI) may be a predictor of morbidity and mortality following lobectomy. MATERIALS: National Surgical Quality Improvement Program (NSQIP) participant use files were reviewed (2005-2010). Patients undergoing lobectomy were identified based on Current Procedural Terminology code 32480. We used an mFI with 11 variables, based on mapping the Canadian Study of Health and Aging Frailty Index to the NSQIP comorbidities. Data were analyzed using χ(2) test, independent sample t-test, Jonckheere-Terpstra test, and logistic regression. RESULTS: Of 1940 open lobectomy patients identified, morbidity and mortality uniformly increased as the mFI increased; 14.9% of patients (75/504) with mFI of 0 had at least one complication, compared with 32% of patients (91/284) with mFI of 0.27 (P < 0.001). An mFI of 0 was associated with a mortality rate of 1% (5/504), compared with 5.6% (16/284) for mFI of 0.27 (P < 0001). Failure to wean from the ventilator, reintubation, surgical site infections, pneumonia, and Clavien 4 and above complications occurred in 1.8% (9/504), 2.6% (13/504), 2.2% (11/504), 5.4% (27/504), and 4.2% (21/504), respectively, in patients with an mFI of 0, compared with 7.4% (21/284), 7% (22/284), 3.2% (9/284), 10.9% (31/284), and 14.4% (41/284), respectively, in patients with mFI of 0.27. CONCLUSIONS: This study demonstrates that the mFI may identify patients at higher risk for morbidity and mortality post-lobectomy. With the aging population, preoperative selection is important in minimizing morbidity and mortality and improving risk stratification for informed decision-making.
Authors: Robert J S Coelen; Jimme K Wiggers; Chung Y Nio; Marc G Besselink; Olivier R C Busch; Dirk J Gouma; Thomas M van Gulik Journal: HPB (Oxford) Date: 2015-02-28 Impact factor: 3.647
Authors: A C Panayi; A R Orkaby; D Sakthivel; Y Endo; D Varon; D Roh; D P Orgill; R L Neppl; H Javedan; S Bhasin; I Sinha Journal: Am J Surg Date: 2018-11-27 Impact factor: 2.565
Authors: Deborah X Xie; Saad C Rehman; David O Francis; James L Netterville; C Gaelyn Garrett; Alexander Gelbard; Brittany Lipscomb; Christopher T Wootten Journal: JAMA Otolaryngol Head Neck Surg Date: 2019-03-01 Impact factor: 6.223
Authors: Mark K Ferguson; Katherine Thompson; Megan Huisingh-Scheetz; Jeanne Farnan; Joshua Hemmerich; Julissa Acevedo; Stephen Small Journal: Ann Thorac Surg Date: 2015-05-23 Impact factor: 4.330
Authors: Jai N Darvall; David Pilcher; Rinaldo Bellomo; Fernando G Zampieri; Theodore J Iwashyna; Elizabeth M Viglianti; Marcio Soares Journal: Intensive Care Med Date: 2018-10-15 Impact factor: 17.440
Authors: Katie S Murray; Megan Prunty; Alex Henderson; Tyler Haden; Naveen Pokala; Bin Ge; Mark Wakefield; Gregory F Petroski; David R Mehr; Robin L Kruse Journal: Urology Date: 2018-08-01 Impact factor: 2.649
Authors: Mark K Ferguson; Jeanne Farnan; Josh A Hemmerich; Kris Slawinski; Julissa Acevedo; Stephen Small Journal: Ann Thorac Surg Date: 2014-06-02 Impact factor: 4.330