Association of Frailty with Perioperative Outcomes Following Hepatic Resection: A National Study

Madrigal, Josef; Hadaya, Joseph; Lee, Cory; Tran, Zachary; Benharash, Peyman

doi:10.1016/j.jamda.2022.02.004

Cited by 6 publications

(6 citation statements)

References 47 publications

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“…A study using HFRS found frailty was associated with higher mortality, hepatic encephalopathy risk, longer hospital stays, and increased costs in surgically treated HCC patients [31]. Similarly, frailty in older hepatectomy patients was correlated with elevated mortality, complications, longer stays, and costs [32], aligning with our findings. Frailty also impacted outcomes following resections for colorectal cancer liver metastases [33].…”

Section: Frailty and Hepatic Lobectomy For Iccsupporting

confidence: 88%

Impact of Frailty on Short-Term Outcomes of Hepatic Lobectomy in Patients with Intrahepatic Cholangiocarcinoma: Evidence from the US Nationwide Inpatient Sample 2005–2018

Xu,

Shao,

Huang

et al. 2024

Dig Surg

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Introduction: This study aimed to evaluate associations between frailty and outcomes in patients with ICC undergoing hepatic lobectomy using a large, nationally representative sample. Methods: This population-based, retrospective observational study extracted the data of adults ≥ 20 years old with ICC undergoing hepatic lobectomy from the US Nationwide Inpatient Sample (NIS) database between 2005 and 2018. Frailty was assessed by the validated Hospital Frailty Risk Score (HFRS). Associations between frailty and surgical outcomes were analyzed using logistic regression analyses. Results: After exclusions, 777 patients were enrolled, including 427 frail and 350 non-frail. Patients’ mean age was 64.5 (± 0.4) years and the majority were males (51.1%), and Whites (76.5%). Frailty was significantly associated with increased odds of in-hospital mortality (aOR: 18.51, 95%CI: 6.70, 51.18), non-home discharge (aOR: 3.58, 95%CI: 2.26, 5.66), prolonged LOS (aOR: 5.56, 95%CI: 3.87, 7.99), perioperative cardiac arrest/stroke (aOR: 5.44, 95%CI: 1.62, 18.24), acute respiratory distress syndrome (ARDS)/respiratory failure (aOR: 3.88, 95%CI: 2.40, 6.28), tracheostomy/ventilation (aOR: 3.83, 95%CI: 2.23, 6.58), bleeding/transfusion (aOR: 1.67, 95%CI: 1.24, 2.26), acute kidney injury (AKI) (aOR: 14.37, 95%CI: 7.13, 28.99), postoperative shock (aOR: 4.44, 95%CI: 2.54, 7.74), and sepsis (aOR: 11.94, 95%CI: 6.90, 20.67). Discussion/Conclusion: Among patients with ICC undergoing hepatic lobectomy, HFRS-defined frailty is a strong predictor of worse in-patient outcomes, including in-hospital death, prolonged LOS, unfavorable discharge, and complications (perioperative cardiac arrest/stroke, ARDS/respiratory failure, tracheostomy/ventilation, bleeding/transfusion, AKI, postoperative shock and sepsis). Study results may help stratify risk in frail patients undergoing hepatic resection for ICC.

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Section: Frailty and Hepatic Lobectomy For Iccsupporting

confidence: 88%

Impact of Frailty on Short-Term Outcomes of Hepatic Lobectomy in Patients with Intrahepatic Cholangiocarcinoma: Evidence from the US Nationwide Inpatient Sample 2005–2018

Xu,

Shao,

Huang

et al. 2024

Dig Surg

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“…A large body of literature has demonstrated frailty to consistently portend inferior postoperative outcomes in both emergent and elective settings, irrespective of the assessment method [5][6][7][8][9][10]. However, detailed frailty assessment tests such as gait speed and grip strength may be impractical in the emergent settings.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional risk factors aside, a large body of literature has demonstrated frailty to be a strong, independent marker for increased mortality and perioperative complications [5][6][7][8][9][10]. Frailty is a multifaceted clinical syndrome characterized as a state of physical and cognitive decline, increased vulnerability to stressors and social withdrawal [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Association of frailty with outcomes of resection for colonic volvulus: A national analysis

Ebrahimian¹,

Lee²,

Tran

et al. 2022

PLoS ONE

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Background With limited national studies available, we characterized the association of frailty with outcomes of surgical resection for colonic volvulus. Methods Adults with sigmoid or cecal volvulus undergoing non-elective colectomy were identified in the 2010–2019 Nationwide Readmissions Database. Frailty was identified using the Johns Hopkins indicator which utilizes administrative codes. Multivariable models were developed to examine the association of frailty with in-hospital mortality, perioperative complications, stoma use, length of stay, hospitalization costs, non-home discharge, and 30-day non-elective readmissions. Results An estimated 66,767 patients underwent resection for colonic volvulus (Sigmoid: 39.6%; Cecal: 60.4%). Using the Johns Hopkins indicator, 30.3% of patients with sigmoid volvulus and 15.9% of those with cecal volvulus were considered frail. After adjustment, frail patients had higher risk of mortality compared to non-frail in both sigmoid (10.6% [95% CI 9.47–11.7] vs 5.7% [95% CI 5.2–6.2]) and cecal (10.4% [95% CI 9.2–11.6] vs 3.5% [95% CI 3.2–3.8]) volvulus cohorts. Frailty was associated with greater odds of acute venous thromboembolism occurrences (Sigmoid: AOR 1.50 [95% CI 1.18–1.94]; Cecal: AOR 2.0 [95% CI 1.50–2.72]), colostomy formation (Sigmoid: AOR 1.73 [95% CI 1.57–1.91]; Cecal: AOR 1.48 [95% CI 1.10–2.00]), non-home discharge (Sigmoid: AOR 1.97 [95% CI 1.77–2.20]; Cecal: AOR 2.56 [95% CI 2.27–2.89]), and 30-day readmission (Sigmoid: AOR 1.15 [95% CI 1.01–1.30]; Cecal: AOR 1.26 [95% CI 1.10–1.45]). Frailty was associated with incremental increase in length of stay (Sigmoid: +3.4 days [95% CI 2.8–3.9]; Cecal: +3.8 days [95% CI 3.3–4.4]) and costs (Sigmoid: +$7.5k [95% CI 5.9–9.1]; Cecal: +$12.1k [95% CI 10.1–14.1]). Conclusion Frailty, measured using a simplified administrative tool, is associated with significantly worse clinical and financial outcomes following non-elective resections for colonic volvulus. Standard assessment of frailty may aid risk-stratification, better inform shared-decision making, and guide healthcare teams in targeted resource allocation in this vulnerable patient population.

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“…9,17 In the field of liver surgery, preoperative frailty is associated with an increased risk of postoperative mortality and morbidity, as well as longer hospital stays. 10,18 In a previous study, we evaluated the feasibility and outcomes of surgical treatment for elderly patients with various types of cancer in terms of physical and mental status and oncology. Then, we established the geriatric prognostic scoring system for gastrointestinal cancer.…”

Section: Introductionmentioning

confidence: 99%

Geriatric prognostic scoring system predicts survival after hepatectomy for elderly patients with liver cancer

Sakano,

Noda,

Kobayashi

et al. 2023

Annals of Gastroent Surgery

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AimThe number of elderly patients with liver cancer is increasing with the aging society. The Geriatric Prognostic Scoring System is useful in predicting the postoperative prognosis for elderly patients with gastrointestinal cancer. The aim of the present study was to assess the predictive ability of the geriatric prognostic scoring system for postoperative survival in elderly patients with liver cancer.MethodsEighty‐eight patients aged ≥75 years who were treated for primary liver cancer and metastatic liver tumor were retrospectively analyzed. The Geriatric Prognostic Score (GPS) was created by several clinical parameters such as age, sex, type of cancer, stage, performance status, body mass index, and comprehensive geriatric assessment. Each patient was divided into two groups of high‐risk to low‐risk according to their GPS: ≧30 high‐risk group and <30 low‐risk. The predictive ability of geriatric prognostic scoring system for postoperative survival was assessed in univariate and multivariate analyses.ResultsOf the 88 patients, 75 were diagnosed as hepatocellular carcinoma and 13 as colorectal liver metastasis. After geriatric prognostic scoring system assessments, 26 patients were diagnosed as high‐risk and the remaining 62 as low‐risk. The 3‐year overall survival rates were 78.5% in the low‐risk group and 35.1% in the high‐risk group (p < 0.001). The univariate and multivariate analyses of overall survival identified high GPS as an independent significant factor (p < 0.001).ConclusionsWe could conclude that the geriatric prognostic scoring system is useful in predicting patients' prognosis after hepatectomy and it can provide helpful information to surgeons for determining treatment strategies for elderly patients with liver cancer.

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Association of Frailty with Perioperative Outcomes Following Hepatic Resection: A National Study

Cited by 6 publications

References 47 publications

Impact of Frailty on Short-Term Outcomes of Hepatic Lobectomy in Patients with Intrahepatic Cholangiocarcinoma: Evidence from the US Nationwide Inpatient Sample 2005–2018

Impact of Frailty on Short-Term Outcomes of Hepatic Lobectomy in Patients with Intrahepatic Cholangiocarcinoma: Evidence from the US Nationwide Inpatient Sample 2005–2018

Association of frailty with outcomes of resection for colonic volvulus: A national analysis

Geriatric prognostic scoring system predicts survival after hepatectomy for elderly patients with liver cancer

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