A modified frailty index predicts adverse outcomes among patients with colon cancer undergoing surgical intervention

Pandit, Viraj; Khan, Muhammad; Martínez, Carolina; Jehan, Faisal; Zeeshan, Muhammad; Koblinski, Jenna E.; Hamidi, Mohammad; Omesieta, Pamela; Osuchukwu, Obiyo; Nfonsam, Valentine

doi:10.1016/j.amjsurg.2018.07.006

Cited by 39 publications

(49 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Forest plot showed that frailty was associated with an increased risk of postoperative complications (OR: 2.36, 95% CI: 1.66-3.35, P<0.01; I 2 = 12%) ( Figure 3A). Similar result was observed in patients who underwent elective surgery (OR: 2.50, 95% CI: 1.72-3.63, P<0.01; I 2 = 15%) [17,21,24,26] ( Figure 3B). The pooled risk estimate of being frail on severe complications was increased by 2.35-fold (95% CI: 1.30-4.27, P<0.01; I 2 = 72%) compared to that of being non-frail [17,23,27] ( Figure 3C).…”

Section: Postoperative Complicationssupporting

confidence: 84%

“…When multivariate risk estimate was unavailable, univariate risk estimate was used instead. Indirect methods of extracting estimates were used, where risk effect was not directly reported in the publication [16,21,22]. The OR and 95% con dence interval (CI) were calculated.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 69332 patients (males: 50.9% (35240/69249) reported in 9 unique studies) who received surgery for CRC were eventually included in the systematic review and meta-analysis (Table 1). Seven articles of 6 studies [16,17,[22][23][24][25][26] presented a prospective observational design reporting longitudinal data, while data from the remaining 3 studies were retrospectively analyzed [8,21,27]. Study characteristics including population, study design, sample size frailty assessment instrument and risk estimates were summarized in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Six studies [17,21,22,24,26,27] reported overall postoperative complications in comparison between frail and non-frail patients ( Table 2). Forest plot showed that frailty was associated with an increased risk of postoperative complications (OR: 2.36, 95% CI: 1.66-3.35, P<0.01; I 2 = 12%) ( Figure 3A).…”

Section: Postoperative Complicationsmentioning

confidence: 99%

“…Because aggressive treatment (e.g. curative surgery) contributes to dysregulation of systemic immune system, causing progressive organ damage and exacerbating decline in physiological reserve [21], identifying frail patients in elderly population is essentially crucial in decision-making and therapeutic options. Moreover, postoperative outcome(s) leading to prolonged inpatient stay incurs substantial additional costs of medical care, and at the same time leading to poorer quality of life and increased risk of emergency readmission [30].…”

Section: Impact Of Frailty On Postoperative Outcomes In Patients Recementioning

confidence: 99%

See 4 more Smart Citations

Does frailty predict postoperative outcomes in geriatric patients receiving surgery for colorectal cancer? A systematic review and meta-analysis

Yang¹,

Xu²,

Cao³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Surgery remains the mainstay of colorectal cancer (CRC) and substantially reduces cancer-related morbidity and mortality. Preoperative assessment for frailty in geriatric patients is critically important in risk stratification and clinical decision-making. In this systematic review and meta-analysis, we aimed to quantitatively summarise the effect of frailty on postoperative outcomes in geriatric patients receiving surgery for CRC. Methods A systematic literature search was conducted in MEDLINE, Cochrane and EMBASE from inception to 30 April 2020. Fully published articles reporting risk estimate(s) of frailty on postoperative complication(s), readmission and/ or mortality in patients aged ≥65 years who received surgery for CRC were eligible for qualitative and quantitative analyses. Results Across 10 articles of 9 unique studies (n = 69332) that were eventually included in the systematic review and meta-analysis, overall prevalence of frailty was 23.0% (95% CI: 11–43%, I 2 = 100%). Odds ratios (ORs) on overall and severe postoperative complications were respectively increased by 2.36- (95% CI: 1.66–3.35, P <0.01; I 2 = 12%) and 2.35-fold (95% CI: 1.30–4.27, P <0.01; I 2 = 72%) in frail patients compared to non-frail counterparts. On pooled analysis, frailty was significantly associated with an increased risk of postoperative readmission (OR:1.91; 95% CI: 1.35–2.70, P <0.01; I 2 = 6%). Whilst a significantly higher risk of frailty on mortality during 12 months after CRC surgery was observed (OR: 5.52; 95% CI:4.40–6.92, P <0.01; I 2 = 89%), the summary OR on 30-day/ inpatient mortality crossed the null line (OR: 1.65; 95% CI: 0.56–4.93, P = 0.37; I 2 = 55%). Funnel plot and Duval-Tweedie’s trim and fill test did not reveal significant publication bias. Conclusions In the studies reviewed, frailty appeared to be associated with increased risks for postoperative complications, readmission and mortality during 12 months in patients aged ≥65 years who received surgery for CRC. Nevertheless, no significant association between frailty and 30-day/ inpatient postoperative mortality was observed.

show abstract

Section: Postoperative Complicationssupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Postoperative Complicationsmentioning

confidence: 99%

Section: Impact Of Frailty On Postoperative Outcomes In Patients Recementioning

confidence: 99%

See 3 more Smart Citations

Does frailty predict postoperative outcomes in geriatric patients receiving surgery for colorectal cancer? A systematic review and meta-analysis

Yang¹,

Xu²,

Cao³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

Impact of malnutrition and frailty on mortality and major amputation in patients with CLTI

Karim

Li²,

Panhwar

et al. 2022

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives To understand the prevalence of malnutrition and its association with chronic limb‐threatening ischemia (CLTI) outcomes; to clarify the differential impact of revascularization methods on outcomes; to assess the ability of the CLTI Frailty Risk Score (CLTI‐FRS) to predict adverse events in patients hospitalized with CLTI. Background Despite advances in the management of CLTI, a majority still undergo major amputation, and a minority heal within 6 months. There is a lack of validated assessment tools for the identification and management of frailty and malnutrition in these patients. Methods Using the National Inpatient Sample from January 2012 to September 2015, we identified all patients with CLTI using International Classification of Diseases Ninth Edition Clinical Modification codes. The cohort was divided into three groups according to nutritional status. Multivariable regression analysis was used to analyze the interaction between malnutrition and outcomes of interest. Results Of 1,414,080 CLTI‐related hospitalizations, 163,835 (11.6%) were malnourished, 332,855 (23.5%) patients were frail, 917,390 (64.9%) were well‐nourished. In‐hospital mortality, major amputation, the average length of stay, and hospital costs were highest among malnourished or frail patients and lowest in well‐nourished patients (p < 0.001). Malnourished and frail patients were observed to have lower rates of mortality with endovascular revascularization as compared to surgical (adjusted odds ratios: 0.675 [0.533–0.854; p = 0.001]). Conclusion Many patients with CLTI are malnourished or frail, and this is associated with mortality and amputation. Both malnourished and frail patients were observed to have a mortality benefit with a less invasive approach to revascularization. Better assessment of nutritional and frailty status of CLTI patients may guide therapy and help prevent amputation and death.

show abstract

Colorectal Cancer

Pitchumoni

2021

Geriatric Gastroenterology

View full text Add to dashboard Cite

A modified frailty index predicts adverse outcomes among patients with colon cancer undergoing surgical intervention

Cited by 39 publications

References 32 publications

Does frailty predict postoperative outcomes in geriatric patients receiving surgery for colorectal cancer? A systematic review and meta-analysis

Does frailty predict postoperative outcomes in geriatric patients receiving surgery for colorectal cancer? A systematic review and meta-analysis

Impact of malnutrition and frailty on mortality and major amputation in patients with CLTI

Colorectal Cancer

Contact Info

Product

Resources

About