Sarah A Vermillion1, Fang-Chi Hsu2, Robert D Dorrell1, Perry Shen3, Clancy J Clark3. 1. Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina. 2. Division of Public Health Sciences, Wake Forest Baptist Health, Winston Salem, North Carolina. 3. Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston Salem, North Carolina.
Abstract
BACKGROUND AND OBJECTIVES: Frailty disproportionately impacts older patients with gastrointestinal cancer, rendering them at increased risk for poor outcomes. A frailty index may aid in preoperative risk stratification. We hypothesized that high modified frailty index (mFI) scores are associated with adverse outcomes after tumor resection in older, gastrointestinal cancer patients. METHODS: Patients (60-90 years old) who underwent gastrointestinal tumor resection were identified in the 2005-2012 NSQIP Participant Use File. 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) were identified. The most prevalent form of cancer was colorectal (69.3%, n = 28 708) and 2.8% of patients were frail (n = 1,164). Frail patients were significantly more likely to have increased length of stay (11.7 vs 9.0 days), major complications (29.1% vs 17.9%), and 30-day mortality (5.6% vs 2.5%), (all P < 0.001). Multivariate analysis identified mFI 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). CONCLUSIONS: mFI was associated with the incidence of postoperative complications and mortality in older surgical patients with gastrointestinal cancer.
BACKGROUND AND OBJECTIVES: Frailty disproportionately impacts older patients with gastrointestinal cancer, rendering them at increased risk for poor outcomes. A frailty index may aid in preoperative risk stratification. We hypothesized that high modified frailty index (mFI) scores are associated with adverse outcomes after tumor resection in older, gastrointestinal cancerpatients. METHODS:Patients (60-90 years old) who underwent gastrointestinal tumor resection were identified in the 2005-2012 NSQIP Participant Use File. 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) were identified. The most prevalent form of cancer was colorectal (69.3%, n = 28 708) and 2.8% of patients were frail (n = 1,164). Frail patients were significantly more likely to have increased length of stay (11.7 vs 9.0 days), major complications (29.1% vs 17.9%), and 30-day mortality (5.6% vs 2.5%), (all P < 0.001). Multivariate analysis identified mFI 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). CONCLUSIONS: mFI was associated with the incidence of postoperative complications and mortality in older surgical patients with gastrointestinal cancer.
Authors: Karl Y Bilimoria; Yaoming Liu; Jennifer L Paruch; Lynn Zhou; Thomas E Kmiecik; Clifford Y Ko; Mark E Cohen Journal: J Am Coll Surg Date: 2013-09-18 Impact factor: 6.113
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Meera R Chappidi; Max Kates; Hiten D Patel; Jeffrey J Tosoian; Deborah R Kaye; Nikolai A Sopko; Danny Lascano; Jen-Jane Liu; James McKiernan; Trinity J Bivalacqua Journal: Urol Oncol Date: 2016-02-15 Impact factor: 3.498
Authors: Megan A Feng; Daniel T McMillan; Karen Crowell; Hyman Muss; Matthew E Nielsen; Angela B Smith Journal: J Surg Res Date: 2014-07-05 Impact factor: 2.192
Authors: Chelsia Gillis; Chao Li; Lawrence Lee; Rashami Awasthi; Berson Augustin; Ann Gamsa; A Sender Liberman; Barry Stein; Patrick Charlebois; Liane S Feldman; Francesco Carli Journal: Anesthesiology Date: 2014-11 Impact factor: 7.892
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: X Serra-Aracil; S Serra-Pla; L Mora-Lopez; A Pallisera-Lloveras; M Labro-Ciurans; S Navarro-Soto Journal: Surg Endosc Date: 2018-06-22 Impact factor: 4.584
Authors: Fernando G Zampieri; Theodore J Iwashyna; Elizabeth M Viglianti; Leandro U Taniguchi; William N Viana; Roberto Costa; Thiago D Corrêa; Carlos Eduardo N Moreira; Marcelo O Maia; Giulliana M Moralez; Thiago Lisboa; Marcus A Ferez; Carlos Eduardo F Freitas; Clayton B de Carvalho; Bruno F Mazza; Mariza F A Lima; Grazielle V Ramos; Aline R Silva; Fernando A Bozza; Jorge I F Salluh; Marcio Soares Journal: Intensive Care Med Date: 2018-08-13 Impact factor: 17.440
Authors: Khodayar Goshtasbi; Arash Abiri; Brandon M Lehrich; Mehdi Abouzari; Harrison W Lin; Hamid R Djalilian; Frank P K Hsu; Edward C Kuan Journal: J Clin Neurosci Date: 2021-07-26 Impact factor: 2.116
Authors: Christopher G Smith; Daniel L Davenport; Justin Gorski; Anthony McDowell; Brian T Burgess; Tricia I Fredericks; Lauren A Baldwin; Rachel W Miller; Christopher P DeSimone; Charles S Dietrich; Holly H Gallion; Edward J Pavlik; John R van Nagell; Frederick R Ueland Journal: Healthcare (Basel) Date: 2019-07-03