Shogo Tanaka1, Masaki Ueno2, Hiroya Iida3, Masaki Kaibori4, Takeo Nomi5, Fumitoshi Hirokawa6, Hisashi Ikoma7, Takuya Nakai8, Hidetoshi Eguchi9, Shoji Kubo1. 1. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 2. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. 3. Division of Gastrointestinal, Breast and General Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan. 4. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan. 5. Department of Surgery, Nara Medical University, Kashihara, Nara, Japan. 6. Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan. 7. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 8. Department of Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Osaka, Japan. 9. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
Abstract
BACKGROUND: Age-related events, such as cardiopulmonary complications, delirium, transfer to a rehabilitation facility, and dependency are a major problem after hepatic resection in the elderly. This prospective multicenter study aimed to preoperatively evaluate frailty in the elderly according to a phenotypic frail index, named the "Kihon Checklist (KCL)," to predict "age-related events" after hepatic resection. METHODS: Between May 2016 and September 2017, 217 independently living patients who consented among all patients aged ≥65 years who planned to undergo hepatic resection were included in the study. Preoperative frailty was defined as a total KCL score ≥8. We analyzed clinical characteristics and outcomes, including age-related events (major respiratory and cardiac complications, delirium medication needed, transfer to rehabilitation facility, and dependency) between patients with and without frailty. RESULTS: Of the 217 patients, 63 and 154 were classified into the frail and non-frail groups, respectively. The incidences of age-related events (31.7% vs. 7.8%, P < 0.001) were higher in the frail group. Multivariate analysis indicated that frailty (P < 0.001, hazard ratio 5.16) and resection of ≥2 sectors (P = 0.014, hazard ratio 2.98) were independent risk factors for age-related events. CONCLUSIONS: Frailty evaluated by KCL in the elderly can predict postoperative age-related events after hepatic resection.
BACKGROUND: Age-related events, such as cardiopulmonary complications, delirium, transfer to a rehabilitation facility, and dependency are a major problem after hepatic resection in the elderly. This prospective multicenter study aimed to preoperatively evaluate frailty in the elderly according to a phenotypic frail index, named the "Kihon Checklist (KCL)," to predict "age-related events" after hepatic resection. METHODS: Between May 2016 and September 2017, 217 independently living patients who consented among all patients aged ≥65 years who planned to undergo hepatic resection were included in the study. Preoperative frailty was defined as a total KCL score ≥8. We analyzed clinical characteristics and outcomes, including age-related events (major respiratory and cardiac complications, delirium medication needed, transfer to rehabilitation facility, and dependency) between patients with and without frailty. RESULTS: Of the 217 patients, 63 and 154 were classified into the frail and non-frail groups, respectively. The incidences of age-related events (31.7% vs. 7.8%, P < 0.001) were higher in the frail group. Multivariate analysis indicated that frailty (P < 0.001, hazard ratio 5.16) and resection of ≥2 sectors (P = 0.014, hazard ratio 2.98) were independent risk factors for age-related events. CONCLUSIONS: Frailty evaluated by KCL in the elderly can predict postoperative age-related events after hepatic resection.
Authors: Natasha Leigh; Gregory A Williams; Steven M Strasberg; Ryan C Fields; William G Hawkins; Chet W Hammill; Dominic E Sanford Journal: Ann Surg Oncol Date: 2022-05-20 Impact factor: 4.339