Chiara Giannotti1, Silvia Sambuceti1, Alessio Signori2, Alberto Ballestrero1, Roberto Murialdo3, Emanuele Romairone4, Stefano Scabini4, Irene Caffa5, Patrizio Odetti1, Alessio Nencioni6, Fiammetta Monacelli7. 1. Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy. 2. Department of Health Science (DISSAL), University of Genoa, 16132 Genoa, Italy. 3. IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy. 4. Oncological Surgery and Implantable Systems, Hospital Policlinic San Martino, Genoa, Italy. 5. Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy. 6. Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy. Electronic address: alessio.nencioni@unige.it. 7. Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy; IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy. Electronic address: fiammetta.monacelli@unige.it.
Abstract
OBJECTIVES: Perioperative frailty assessment is still a challenge, especially in oncogeriatrics. We aimed at assessing the diagnostic accuracy of the 40 items Frailty Index (FI) as compared to the comprehensive geriatric assessment (CGA) for the prediction of one-year mortality and functional status after colorectal surgery in old-age subjects. MATERIAL AND METHODS: Ninety-nine consecutive patients aged 65 years or older who were candidate for elective gastrointestinal cancer surgery, with G8 score ≤ 14 were enrolled and subjected to CGA and to frailty stratification according to the 40-items FI. Long-term outcomes including one-year mortality and functional decline were collected. RESULTS: Mean patient age was 80.3 ± 5.6 years. Colorectal cancer was the most common diagnosis. The most prevalent clinical phenotype was pre-frail. CGA and FI showed similar predictive accuracy in identifying one-year mortality after surgery and patient functional status. Our multivariate analysis indicated the pre-morbid functional status (IADL) and cancer stage as the most significant predictors of one-year mortality. CONCLUSIONS: This is the first study to investigate the prognostic accuracy of the 40-items FI as compared to CGA in a vulnerable octogenarian cancer population. Its results are consistent with patient functional status being a mediator of frailty and with both serving as intertwined markers of clinical vulnerability. In addition, according to our results, cancer and specific environmental stressors, such as surgery, are likely to affect the frailty trajectory.
OBJECTIVES: Perioperative frailty assessment is still a challenge, especially in oncogeriatrics. We aimed at assessing the diagnostic accuracy of the 40 items Frailty Index (FI) as compared to the comprehensive geriatric assessment (CGA) for the prediction of one-year mortality and functional status after colorectal surgery in old-age subjects. MATERIAL AND METHODS: Ninety-nine consecutive patients aged 65 years or older who were candidate for elective gastrointestinal cancer surgery, with G8 score ≤ 14 were enrolled and subjected to CGA and to frailty stratification according to the 40-items FI. Long-term outcomes including one-year mortality and functional decline were collected. RESULTS: Mean patient age was 80.3 ± 5.6 years. Colorectal cancer was the most common diagnosis. The most prevalent clinical phenotype was pre-frail. CGA and FI showed similar predictive accuracy in identifying one-year mortality after surgery and patient functional status. Our multivariate analysis indicated the pre-morbid functional status (IADL) and cancer stage as the most significant predictors of one-year mortality. CONCLUSIONS: This is the first study to investigate the prognostic accuracy of the 40-items FI as compared to CGA in a vulnerable octogenarian cancer population. Its results are consistent with patient functional status being a mediator of frailty and with both serving as intertwined markers of clinical vulnerability. In addition, according to our results, cancer and specific environmental stressors, such as surgery, are likely to affect the frailty trajectory.
Authors: Allison N Martin; Darian L Hoagland; Florence E Turrentine; R Scott Jones; Victor M Zaydfudim Journal: World J Surg Date: 2020-08 Impact factor: 3.352