Giacomo Pata1, Luca Bianchetti2, Matteo Rota3, Alessandra Marengoni2, Deborah Chiesa2, Elisa Cassinotti4, Silvia Palmisano5, Marta Colombi2, Giulio Del Zotto5, Giuseppe Romanelli2, Stefano Calza3,6, Luigi Boni4, Nicolò De Manzini5, Uberto Fumagalli Romario1,7. 1. General Surgery 2 Unit, University Hospital ASST Spedali Civili of Brescia, Brescia, Italy. 2. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 3. Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy. 4. Department of Surgery, Fondazione IRCCS-Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 5. Department of Surgery, Ospedali Riuniti, University of Trieste, Trieste, Italy. 6. Big and Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy. 7. Digestive Surgery Unit, European Institute of Oncology (IEO), IRCCS, Milan, Italy.
Abstract
BACKGROUND: This study aims (I) to evaluate whether the Multidimensional Prognostic Index (MPI) score is associated with postoperative outcomes and (II) to develop a prognostic model for individual complication-risk prediction following colorectal cancer (CRC) surgery. METHOD: This is a prospective multicentric cohort study. Consecutive ≥75-year-old candidates for elective CRC surgery were enrolled from October 2017 to August 2019. Patients underwent standardized preoperative geriatric assessment including the MPI. Patients with MPI score > 0.33 were classified as frail. Logistic regression models were employed to evaluate variables associated with major postoperative complications and mortality, using 10-fold cross-validated LASSO (least absolute shrinkage and selection operator) for model selection. RESULTS: In all, 104 patients were included, 34 (33%) had MPI score > 0.33. Major postoperative complications occurred in 52% of frail versus 16% of fit (MPI score ≤ 0.33) patients (p < .01). Both 30-day (9% vs. 0%; p = .033) and 90-day mortality (18% vs. 1%; p < .01) were higher among frail patients. In multivariate analysis, MPI score was associated with adverse outcomes. A final postoperative complication predictive model was created, including MPI score, gait-speed test, ASA (American Society of Anesthesiology) score, surgical approach, and stoma creation. CONCLUSION: MPI score is strongly associated with postoperative major complications in CRC elderly patients and it is a primary component of an individual prediction model.
BACKGROUND: This study aims (I) to evaluate whether the Multidimensional Prognostic Index (MPI) score is associated with postoperative outcomes and (II) to develop a prognostic model for individual complication-risk prediction following colorectal cancer (CRC) surgery. METHOD: This is a prospective multicentric cohort study. Consecutive ≥75-year-old candidates for elective CRC surgery were enrolled from October 2017 to August 2019. Patients underwent standardized preoperative geriatric assessment including the MPI. Patients with MPI score > 0.33 were classified as frail. Logistic regression models were employed to evaluate variables associated with major postoperative complications and mortality, using 10-fold cross-validated LASSO (least absolute shrinkage and selection operator) for model selection. RESULTS: In all, 104 patients were included, 34 (33%) had MPI score > 0.33. Major postoperative complications occurred in 52% of frail versus 16% of fit (MPI score ≤ 0.33) patients (p < .01). Both 30-day (9% vs. 0%; p = .033) and 90-day mortality (18% vs. 1%; p < .01) were higher among frail patients. In multivariate analysis, MPI score was associated with adverse outcomes. A final postoperative complication predictive model was created, including MPI score, gait-speed test, ASA (American Society of Anesthesiology) score, surgical approach, and stoma creation. CONCLUSION: MPI score is strongly associated with postoperative major complications in CRC elderly patients and it is a primary component of an individual prediction model.
Authors: Ajay T Bakas; Aniel Sewnaik; Jaclyn van Straaten; Robert J Baatenburg de Jong; Francesco U S Mattace-Raso; Harmke A Polinder-Bos Journal: Clin Interv Aging Date: 2021-09-16 Impact factor: 4.458