Frailty: An outcome predictor for elderly gynecologic oncology patients

Courtney‐Brooks, Madeleine; Tellawi, A. Rauda; Scalici, Jennifer; Duska, Linda R.; Jazaeri, Amir A.; Modesitt, Susan C.; Cantrell, Leigh A.

doi:10.1016/j.ygyno.2012.04.019

Cited by 114 publications

(83 citation statements)

References 27 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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“…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. 32 Two of the studies involved comprehensive surgical populations, 33,34 one study involved thoracic surgical patients undergoing lobectomy; 35 two studies used a mix of patients undergoing a mix of surgical procedures, 20,36 and one study involved patients undergoing a mix of minimally invasive surgical procedures.…”

Section: Basic Study Characteristicsmentioning

confidence: 99%

“…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. With respect to 30-day postoperative complications, the OR ranged from as low as 1.05 (95% CI 0.94 to 1.17) in older adult abdominal surgical patients 21 to as high as 11.70 in patients undergoing emergency general surgery.…”

Section: Frailty and Perioperative Surgical Outcomesmentioning

confidence: 99%

Frailty and perioperative outcomes: a narrative review

Beggs

Sepehri

Szwajcer

et al. 2014

Can J Anesth/J Can Anesth

141

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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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“…However, in the case of BMI >30, a notable number of postoperative complications occur [8]. Our own group at the University of Virginia (UVA) also found similar poor 30 day outcomes in a group of elderly patients who were obese [10].…”

Section: Body Mass Indexmentioning

confidence: 57%

Nutrition in Gynecologic Cancer

Cantrell

Saks

Grajales

et al. 2015

Curr Obstet Gynecol Rep

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Nutrition plays a role in every aspect of gynecologic cancer care from diagnosis to death. Unfortunately, the topic is not well researched in gynecology oncology and much that is known about nutrition comes from other disciplines. Nutrition and resultant body mass index (BMI) affects a patient's risk of diagnosis of a gynecologic malignancy, treatment tolerance, complications, and survival. Sadly, 20 % of patients with cancer die of malnutrition rather than their disease. However, not all malnourished patients are thin, as patients with BMIs in the obese range often do not have adequate nutrition. Recent literature challenges previous thoughts about feeding before and after surgery and clearly links obesity and diet quality with survival. More research is needed on the nutrition of patients with gynecologic malignancy, specifically how diet quality interfaces with the tolerance of radiation and chemotherapy.

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Frailty: An outcome predictor for elderly gynecologic oncology patients

Cited by 114 publications

References 27 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

Nutrition in Gynecologic Cancer

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