Assessment of Morbidity and Mortality After Esophagectomy Using a Modified Frailty Index

Hodari, Arielle; Hammoud, Zane T.; Borgi, Jamil; Tsiouris, Athanasios; Rubinfeld, Ilan

doi:10.1016/j.athoracsur.2013.05.051

Cited by 100 publications

(81 citation statements)

References 23 publications

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“…Most studies were observational (23 of 35) with a total of 1 153 684 patients available for the analysis. Cohorts were composed of patients undergoing lower gastrointestinal (GI) surgery (10 studies), upper GI surgery (6), mixed GI surgery (4), gynaecological surgery (6), urological surgery (4) and mixed abdominal surgery (6) ( Table 1)1 12, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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“…In eight studies, mortality was a perioperative outcome associated with frailty. 4,22,24,25,29,32,33,35 There was a wide variety of odds ratios (OR) for mortality reported in these studies, likely due to the variation in surgical population and frailty assessment used. For example, one study involving cardiac surgical patients reported an OR of 1.10 (95% confidence interval [CI] 1.04 to 1.16), 22 while another study conducted in patients undergoing esophagectomy reported a very high OR of 31.84.…”

Section: Frailty and Perioperative Surgical Outcomesmentioning

confidence: 99%

“…For example, one study involving cardiac surgical patients reported an OR of 1.10 (95% confidence interval [CI] 1.04 to 1.16), 22 while another study conducted in patients undergoing esophagectomy reported a very high OR of 31.84. 25 Eight studies showed an association between frailty and the development of postoperative complications. 20,21,26,27,31,34,36,37 As with mortality, a wide variety of ORs was reported for the development of complications, likely also due to the variation in surgical population and frailty assessment used.…”

Section: Frailty and Perioperative Surgical Outcomesmentioning

confidence: 99%

“…To highlight some of the more common assessments, five studies used a replica or modification of the Fried frailty criteria; 23,27,31,34,37 two studies used a replica or modification of the CSHA-FI based on an accumulation of deficits (where the more deficits accumulated the more frail the patient), 21,33 and four studies used a mFI. 25,28,29,35 The other studies utilized a range of frailty assessments, as outlined in Table 3. Clearly, there is a lack of consensus for a clear definition of frailty and for the best assessment tool to use in determining frailty status.…”

Section: Does This Review Mirror the Findings Of Others?mentioning

confidence: 99%

“…Four studies involved patients having cardiac valve surgery (including transcatheter aortic valve repplacement). 4,[22][23][24] Five studies involved a mix of gastrointestinal surgical patients, [25][26][27] including abdominal 21 and other general surgery patients. 28 Two studies involved vascular surgical patients 29,30 and two involved surgical oncology patients with either gynecological neoplasms 31 or gastric adenocarcinoma.…”

Section: Basic Study Characteristicsmentioning

confidence: 99%

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Frailty and perioperative outcomes: a narrative review

Beggs

Sepehri

Szwajcer

et al. 2014

Can J Anesth/J Can Anesth

138

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Background Frailty has no single universally accepted definition or method for assessment. It is commonly defined from a physiological perspective as a disruption of homeostatic mechanisms ultimately leading to a vulnerable state. Numerous scoring indices and assessments exist to assist clinicians in determining the frailty status of a patient. The purpose of this review is to discuss the relationship between frailty and perioperative outcomes in surgical patients. Principal findings We performed a review to determine the association of frailty with perioperative outcomes in patients undergoing a wide variety of surgical procedures. A scoping literature search was performed to capture studies from MEDLINE Ò , EMBASE TM , and CENTRAL (Cochrane), which resulted in locating 175 studies across the three electronic databases. After an article screening process, 19 studies were found that examined frailty and perioperative outcomes. The studies used a range of assessments to determine frailty status and included patients in a variety of surgical fields. Regardless of surgical population and method of frailty assessment, a relationship existed between adverse perioperative outcomes and frailty status. Frail patients undergoing surgical procedures had a higher likelihood than non-frail patients of experiencing mortality, morbidity, complications, increased hospital length of stay, and discharge to an institution. Conclusions Patients undergoing surgery who are deemed frail, regardless of the scoring assessment used, have a higher likelihood of experiencing adverse perioperative outcomes. With the lack of a unified definition for frailty, further research is needed to address which assessment method is most predictive of adverse postoperative outcomes.

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Development and Evaluation of a New Frailty Index for Older Surgical Patients With Cancer

et al. 2019

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Key Points Question Can a more clinically feasible version of the modified Frailty Index for older patients with cancer be developed? Findings In this cohort study of 1137 older patients with cancer, the Memorial Sloan Kettering–Frailty Index (MSK-FI) was associated with aging-related impairments. A higher score on the MSK-FI was also associated with a longer length of stay, higher odds of intensive care unit admission, and lower overall survival. Meaning The MSK-FI may be a feasible tool to perioperatively assess frailty in older patients with cancer.

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Assessment of Morbidity and Mortality After Esophagectomy Using a Modified Frailty Index

Cited by 100 publications

References 23 publications

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Frailty and perioperative outcomes: a narrative review

Development and Evaluation of a New Frailty Index for Older Surgical Patients With Cancer

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