Frailty as a Predictor of Postoperative Morbidity and Mortality Following Liver Resection

Abstract

Background Liver resection is commonly performed among patients at risk of being frail. Frailty can be used to assess perioperative risk. Thus, we evaluated frailty as a predictor of postoperative complications following liver resection using a validated modified frailty index (mFI). Methods A retrospective cohort of consecutive patients undergoing liver resection (2011-2018) were stratified according to the mFI and classified as the following: high (≥.27) and low mFI (<.27). The effect of mFI on postoperative complications (Clavien-Dindo) was evaluated using multiple logistic regression, expressed as odds ratios (OR) and 95% CI. Results Of 409 patients, 58 (14%) had high mFI. There were no differences in type of liver resection (laparoscopic: 57% vs 55%, P = .766), number of segments resected (3 vs 4, P = .417), or operative time (257 vs 293 minutes, P = .097) between the high and low mFI groups, respectively. High mFI patients had a longer median length of hospital stay (9.5 vs 5 days, P < .001) and higher proportion of postoperative complications (79% vs 46%, P < .001), including minor complications (69% vs 42%, P < .001), major complications (50% vs 13%, P < .001), and 90-day postoperative mortality (12% vs 3.4%, P = .04). On multivariable analysis, longer operating time (OR 1.15, 95% CI, 1.03 to 1.27), higher number of segments resected (OR 1.43, 95% CI, 1.12 to 1.82), and high mFI (OR 6.74, 95% CI, 2.76 to 16.51) were independent predictors of major postoperative complications. Discussion mFI predicts postoperative outcomes following liver resection and can be used as a risk stratification tool for patients being considered for surgery.

Associations between different measures of intra-operative tachycardia during noncardiac surgery and adverse postoperative outcomes

“…Numerous studies have examined predictors of adverse cardiovascular outcomes and mortality following Eur J Anaesthesiol 2022; 39:145-151 noncardiac surgery. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] These studies differed in their selection of patients, types of surgery, proportions of emergency procedures and extent of postoperative morbidity. We aimed to identify the definition of intraoperative tachycardia that has the strongest association with adverse postoperative outcomes.…”

Usefulness of frailty to predict short‐ and long‐term outcomes in patients who have undergone major hepatectomy for perihilar cholangiocarcinoma

“…Several studies have revealed the association between poor outcomes and high frailty scores in patients with various disorders, such as cardiovascular diseases, 24 infectious diseases, 25 liver disease, 26 or malignant diseases including gastrointestinal cancer. 4 , 5 , 6 , 7 , 8 , 27 As for hepatic resection, 11 studies 5 , 6 , 7 , 8 , 9 , 10 , 11 , 13 , 14 , 15 , 16 are available to date, among which 10 showed the usefulness of frailty scoring in predicting mortality, morbidity, or prognosis after hepatectomy. Tanaka et al 7 conducted a prospective multicenter study using the Kihon checklist and demonstrated that high frailty was an independent risk factor for age‐related events (major respiratory complications, major cardiac events, delirium requiring medication, transfer to rehabilitation facility, and dependency).…”

“…These patients are often associated with frailty—an impaired physiological condition resulting from aging that increases vulnerability to stress 2,3 . Recently, several studies have reported that frailty is a more significant risk factor than aging for postoperative complications or long‐term survival after surgery for various cancers, including gastrointestinal cancer 4–11 …”

“… 2 , 3 Recently, several studies have reported that frailty is a more significant risk factor than aging for postoperative complications or long‐term survival after surgery for various cancers, including gastrointestinal cancer. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 …”

Sarcopenia and Frailty in Liver Cirrhosis

“…Frailty is a syndrome commonly observed in the elderly [ 65 ]. It encompasses a state of increased vulnerability to environmental factors, but with the reversibility of returning to a healthy state with appropriate intervention [ 66 , 67 , 68 ]. There are physical, psychological and social factors that contribute to frailty [ 65 ].…”