Katharina Anic1, Friedrich Flohr2, Mona Wanda Schmidt2, Slavomir Krajnak2, Roxana Schwab2, Marcus Schmidt2, Christiane Westphalen3, Clemens Eichelsbacher4, Christian Ruckes5, Walburgis Brenner6, Annette Hasenburg2, Marco Johannes Battista2. 1. Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. katharina.anic@unimedizin-mainz.de. 2. Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. 3. Department of Geriatric Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. 4. Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. 5. Interdisciplinary Center Clinical Trials, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. 6. Management of the Scientific Laboratories, University Medical Center of Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
Abstract
OBJECTIVE: Five commonly used global health assessment tools have been evaluated to identify and assess the preoperative frailty status and its relationship with perioperative in-hospital complications and transfusion rates in older women with endometrial cancer (EC). METHODS: Preoperative frailty status was examined by the G8 questionnaire, the Eastern Cooperative Oncology Group performance status, the Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status System, as well as the Lee-Schonberg prognostic index. The main outcome measures were perioperative laboratory values, intraoperative surgical parameters and immediately postoperative complications. RESULTS: 153 consecutive women ≥ 60 years with all stages of EC, who received primary elective surgery at the University Medical Center Mainz between 2008 and 2019 were classified with selected global health assessment tools according to their preoperative performance status. In contrast to conventional prognostic parameters like older age and higher BMI, increasing frailty was significantly associated with preoperative anemia and perioperative transfusions (p < 0.05). Moreover, in patients preoperatively classified as frail significantly more postoperative complications (G8 Score: frail: 20.7% vs. non-frail: 6.7%, p = 0.028; ECOG: frail: 40.9% vs. non-frail: 2.8%, p = 0.002; and CCI: frail: 25.0% vs. non-frail: 7.4%, p = 0.003) and an increased length of hospitalization were recorded. According to propensity score matching, the risk for developing postoperative complications for frail patients was approximately two-fold higher, depending on which global health assessment tool was used. CONCLUSIONS: Preoperatively assessed frailty significantly predicts post-surgical morbidity rates in contrast to conventionally used single prognostic parameters such as age or BMI. A standardized preoperative assessment of frailty in the routine work-up might be beneficial in older cancer patients before major surgery to include these patients in a prehabilitation program with nutrition counseling and physiotherapy to adequately assess the perioperative risk.
OBJECTIVE: Five commonly used global health assessment tools have been evaluated to identify and assess the preoperative frailty status and its relationship with perioperative in-hospital complications and transfusion rates in older women with endometrial cancer (EC). METHODS: Preoperative frailty status was examined by the G8 questionnaire, the Eastern Cooperative Oncology Group performance status, the Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status System, as well as the Lee-Schonberg prognostic index. The main outcome measures were perioperative laboratory values, intraoperative surgical parameters and immediately postoperative complications. RESULTS: 153 consecutive women ≥ 60 years with all stages of EC, who received primary elective surgery at the University Medical Center Mainz between 2008 and 2019 were classified with selected global health assessment tools according to their preoperative performance status. In contrast to conventional prognostic parameters like older age and higher BMI, increasing frailty was significantly associated with preoperative anemia and perioperative transfusions (p < 0.05). Moreover, in patients preoperatively classified as frail significantly more postoperative complications (G8 Score: frail: 20.7% vs. non-frail: 6.7%, p = 0.028; ECOG: frail: 40.9% vs. non-frail: 2.8%, p = 0.002; and CCI: frail: 25.0% vs. non-frail: 7.4%, p = 0.003) and an increased length of hospitalization were recorded. According to propensity score matching, the risk for developing postoperative complications for frail patients was approximately two-fold higher, depending on which global health assessment tool was used. CONCLUSIONS: Preoperatively assessed frailty significantly predicts post-surgical morbidity rates in contrast to conventionally used single prognostic parameters such as age or BMI. A standardized preoperative assessment of frailty in the routine work-up might be beneficial in older cancer patients before major surgery to include these patients in a prehabilitation program with nutrition counseling and physiotherapy to adequately assess the perioperative risk.
Authors: Marije E Hamaker; Judith M Jonker; Sophia E de Rooij; Alinda G Vos; Carolien H Smorenburg; Barbara C van Munster Journal: Lancet Oncol Date: 2012-10 Impact factor: 41.316
Authors: C A Bellera; M Rainfray; S Mathoulin-Pélissier; C Mertens; F Delva; M Fonck; P L Soubeyran Journal: Ann Oncol Date: 2012-01-16 Impact factor: 32.976
Authors: Günter Emons; Eric Steiner; Dirk Vordermark; Christoph Uleer; Nina Bock; Kerstin Paradies; Olaf Ortmann; Stefan Aretz; Peter Mallmann; Christian Kurzeder; Volker Hagen; Birgitt van Oorschot; Stefan Höcht; Petra Feyer; Gerlinde Egerer; Michael Friedrich; Wolfgang Cremer; Franz-Josef Prott; Lars-Christian Horn; Heinrich Prömpeler; Jan Langrehr; Steffen Leinung; Matthias W Beckmann; Rainer Kimmig; Anne Letsch; Michael Reinhardt; Bernd Alt-Epping; Ludwig Kiesel; Jan Menke; Marion Gebhardt; Verena Steinke-Lange; Nils Rahner; Werner Lichtenegger; Alain Zeimet; Volker Hanf; Joachim Weis; Michael Mueller; Ulla Henscher; Rita K Schmutzler; Alfons Meindl; Felix Hilpert; Joan Elisabeth Panke; Vratislav Strnad; Christiane Niehues; Timm Dauelsberg; Peter Niehoff; Doris Mayr; Dieter Grab; Michael Kreißl; Ralf Witteler; Annemarie Schorsch; Alexander Mustea; Edgar Petru; Jutta Hübner; Anne Derke Rose; Edward Wight; Reina Tholen; Gerd J Bauerschmitz; Markus Fleisch; Ingolf Juhasz-Boess; Sigurd Lax; Ingo Runnebaum; Clemens Tempfer; Monika J Nothacker; Susanne Blödt; Markus Follmann; Thomas Langer; Heike Raatz; Simone Wesselmann; Saskia Erdogan Journal: Geburtshilfe Frauenheilkd Date: 2018-11-26 Impact factor: 2.915