Can Fried Frailty Score predict postoperative morbidity and mortality in gynecologic cancer surgery? Results of a prospective study

Inci, Melisa Guelhan; Anders, Louise; Heise, Kathrin; Richter, Rolf; Woopen, Hannah; Sehouli, Jalid

doi:10.1016/j.jgo.2020.09.029

Cited by 9 publications

(6 citation statements)

References 36 publications

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“…Previous studies have identified the ASA PS and ECOG PS as good tools for outcome prediction in cancer patients [3,10,23,26]. Our results suggest that the ECOG PS is more relevant in oncologic surgery than the ASA PS, evaluating how independently a patient can manage everyday life rather than focusing on systemic diseases.…”

Section: Discussionmentioning

confidence: 68%

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ECOG and BMI as preoperative risk factors for severe postoperative complications in ovarian cancer patients: results of a prospective study (RISC-GYN—trial)

Inci

Rasch

Woopen

et al. 2021

Arch Gynecol Obstet

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Background Accompanying co-morbidities in patients with ovarian cancer are of major relevance for scheduling debulking surgery, especially in the anesthesiological consultations. Aim of this study was to evaluate the impact of co-morbidities and patient characteristics on postoperative complications. Methods Patients undergoing maximal cytoreductive surgery were prospectively enrolled from October 2015 to January 2017. Various variables were recorded, such as the Charlson comorbidity index, Eastern cooperative oncology group scale of performance status (ECOG PS) and the American society of anesthesiologists physical status classification system (ASA PS). Surgical complications were graded using the Clavien–Dindo criteria. Logistic regression models were used to analyze risk factors for severe postoperative complications. Results Of 106 enrolled patients, 19 (17.9%) developed severe postoperative complications grade ≥ IIIb according to Clavien–Dindo criteria. In the multivariable regression analysis impaired (ECOG PS) > 1 (odds ratio OR) 13.34, 95% confidence interval (CI) 1.74–102.30, p = 0.01), body mass index (BMI) > 25 kg/m2 (OR 10.48, 95% CI 2.38–46.02, p = 0.002) along with the use of intraoperative norepinephrine > 0.11 µg/kg/min (OR 4.69, 95% CI 1.13–19.46, p = 0.03) and intraoperative fresh frozen plasma (FFP) > 17 units (OR 4.11, 95% CI 1.12–15.14, p = 0.03) appeared as significant predictors of severe postoperative complications. Conclusion We demonstrated that neither the presence of a certain comorbidity nor the summation of the co-morbidities were associated with adverse outcome. Patient characteristics, such as ECOG PS > 1 and obesity (BMI > 25 kg/m2), are highly predictive factors for severe postoperative complications. The analysis of intraoperative data showed that the need for more than > 0.11 µg/kg/min of norepinephrine and transfusions of FFPs more than 17 units were strongly associated with severe postoperative complications.

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Section: Discussionmentioning

confidence: 68%

“…Several publications focusing on ovarian cancer showed obesity as a highly predictive factor for postoperative complications [10,[26][27][28][29][30][31][32]. Extreme BMIs-both high and low, have been found to be associated with severe postoperative complications [10].…”

Section: Discussionmentioning

confidence: 99%

ECOG and BMI as preoperative risk factors for severe postoperative complications in ovarian cancer patients: results of a prospective study (RISC-GYN—trial)

Inci

Rasch

Woopen

et al. 2021

Arch Gynecol Obstet

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“…43 In a prospective study on gynecologic cancer patients, our study group could reveal that ECOG status can predict severe postoperative complications more precisely than Fried Frailty Score. 44 Our investigation has some limitations. The enrolled patients had different types of gynecologic cancers in varying stages of disease (FIGO I to FIGO IV A).…”

Section: Discussionmentioning

confidence: 90%

“…The ECOG performance status refers to fitness and functioning in daily life of oncological patients and can be utilized as a complementary tool in assessing the patients' functional health status 43 . In a prospective study on gynecologic cancer patients, our study group could reveal that ECOG status can predict severe postoperative complications more precisely than Fried Frailty Score 44 …”

Section: Discussionmentioning

confidence: 99%

Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study

Sehouli

Mueller

Richter

et al. 2021

J cachexia sarcopenia muscle

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Background Malnutrition and sarcopenia often occur simultaneously in cancer patients and are thought to have harmful effects on both surgical and oncological outcomes. Therefore, we want to evaluate the effects of sarcopenia and malnutrition on severe postoperative complications and overall survival in gynecologic cancer patients. Methods We assessed nutritional parameters and run a bioelectrical impedance analysis in 226 women. Extracellular mass to body cell mass index, phase angle alpha, muscle mass, and fat mass were evaluated. To determine if patients suffer from sarcopenia, we ran the Timed 'Up and Go' test, performed hand grip strength, and calculated a skeletal muscle index. Postoperative complications were categorized using Clavien-Dindo Classification. Utilizing ROC analysis and logistic regression, we determined predictive clinical factors for severe postoperative complications. Kaplan-Meier method and log-rank test were used for overall survival analysis. Results Of the 226 female patients, 120 (53%) had a BMI ≥ 25 kg/m 2 , 56 (26%) had a phase angle < 4.75°, and 68 (32%) were sarcopenic according to skeletal muscle index < 27%. Within 30 days after surgery, 40 (18%) patients developed severe postoperative complications, and 4% had died. According to multivariable regression analysis, ECOG status

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“…Previous works demonstrated a strong association between the physical part of the EORTC QLQ-C30 and severe postoperative complications [ 11 , 12 , 13 ]. In particular, functioning domains such as low physical ability and some specific symptoms, most notably, pain, fatigue, and loss of appetite, were associated with poorer survival in cancer patients [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HR-QoL) in Patients with Ovarian Cancer: What Is Different Compared to Healthy Women?

Inci

Richter

Heise

et al. 2021

Cancers

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Introduction: The aim of this analysis was to evaluate the health-related quality of life (HR-QoL) in patients with ovarian cancer using a patient-reported outcome (PRO) based questionnaire and to compare it to the healthy female population in Germany and to other ovarian cancer patients worldwide. Additionally, we looked for differences in the HR-QoL with respect to the patients’ ages in our cohort. Methods: The HR-QoL for 155 enrolled patients with ovarian cancer was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) prior to surgery and then compared with 501 healthy females in Germany, as well as to the previously published European Organization for Research and Treatment of Cancer (EORTC) reference data for 917 patients with ovarian cancer worldwide. Moreover, we grouped our cohort by ages <65 and >65 years and analyzed them for further differences. To identify the differences, T-tests were applied. Results: Overall, 155 patients were enrolled, and 126 patients had advanced-stage ovarian cancer (FIGO III–IV) (82.4%). Fifty-five (36%) patients were >65 years. Except for the physical functioning scale, all other domains of the functioning scales were significantly lower in our patients with ovarian cancer than in the healthy female population. The emotional (50 points versus 60 points, p = 0.02), cognitive (76 points versus 88 points, p = 0.005), and social functioning scales (68 points versus 81 points, p = 0.006) were lower in the younger subgroup. Further, the younger subgroup exhibited significantly more fatigue (40 points versus 29 points, p = 0.03) and financial difficulties (20 points versus 2 points, p < 0.001) than the older subgroup. Discussion: Interestingly, the patients with ovarian cancer had no significant differences in the physical functioning scale when compared with the healthy women. In contrast, the patients, especially in the younger group, needed special support for the emotional and social areas of their daily lives.

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Can Fried Frailty Score predict postoperative morbidity and mortality in gynecologic cancer surgery? Results of a prospective study

Cited by 9 publications

References 36 publications

ECOG and BMI as preoperative risk factors for severe postoperative complications in ovarian cancer patients: results of a prospective study (RISC-GYN—trial)

ECOG and BMI as preoperative risk factors for severe postoperative complications in ovarian cancer patients: results of a prospective study (RISC-GYN—trial)

Effects of sarcopenia and malnutrition on morbidity and mortality in gynecologic cancer surgery: results of a prospective study

Patient-Reported Outcomes (PROs) and Health-Related Quality of Life (HR-QoL) in Patients with Ovarian Cancer: What Is Different Compared to Healthy Women?

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