Frailty assessment tools predict perioperative outcome in elderly patients with endometrial cancer better than age or BMI alone: a retrospective observational cohort study

Abstract

Objective Five commonly used global health assessment tools have been evaluated to identify and assess the preoperative frailty status and its relationship with perioperative in-hospital complications and transfusion rates in older women with endometrial cancer (EC). Methods Preoperative frailty status was examined by the G8 questionnaire, the Eastern Cooperative Oncology Group performance status, the Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status System, as well as the Lee-Schonberg prognostic index. The main outcome measures were perioperative laboratory values, intraoperative surgical parameters and immediately postoperative complications. Results 153 consecutive women ≥ 60 years with all stages of EC, who received primary elective surgery at the University Medical Center Mainz between 2008 and 2019 were classified with selected global health assessment tools according to their preoperative performance status. In contrast to conventional prognostic parameters like older age and higher BMI, increasing frailty was significantly associated with preoperative anemia and perioperative transfusions (p < 0.05). Moreover, in patients preoperatively classified as frail significantly more postoperative complications (G8 Score: frail: 20.7% vs. non-frail: 6.7%, p = 0.028; ECOG: frail: 40.9% vs. non-frail: 2.8%, p = 0.002; and CCI: frail: 25.0% vs. non-frail: 7.4%, p = 0.003) and an increased length of hospitalization were recorded. According to propensity score matching, the risk for developing postoperative complications for frail patients was approximately two-fold higher, depending on which global health assessment tool was used. Conclusions Preoperatively assessed frailty significantly predicts post-surgical morbidity rates in contrast to conventionally used single prognostic parameters such as age or BMI. A standardized preoperative assessment of frailty in the routine work-up might be beneficial in older cancer patients before major surgery to include these patients in a prehabilitation program with nutrition counseling and physiotherapy to adequately assess the perioperative risk.

Impact of perioperative red blood cell transfusion, anemia of cancer and global health status on the prognosis of elderly patients with endometrial and ovarian cancer

“…postoperative prognosis (54,55,58). Consecutively, the frailty status was seen as a potential confounder in this study and was included in the multivariate analyses.…”

“…The G8 geriatric screening tool (G8 score) is one of the most commonly used rapid geriatric screening questionnaires (52,53). The G8 score has been evaluated especially in oncologicalsurgical disciplines because of its main focus on nutrition, mobility, and comorbidities (54,55).…”

Influence of interdisciplinary frailty screening on perioperative complication rates in elderly ovarian cancer patients: results of a retrospective observational study

“…In conclusion, the preoperative classification as G8-frail has been shown to be a significant risk factor for increased in-hospital morbidity in elderly women with gynecological cancer [ 61 ]. Moreover, we could demonstrate the G8 Score as “an independent prognostic marker in elderly patients with OC independently of maximal surgical effort” [ 21 ].…”

Assessing the Significance of Lymphadenectomy in Older Patients with Stage I Endometrial Cancer: A Single-Center, Retrospective Cohort Study

“…and mental function of older patients (Eamer et al 2018). CGA was also reported to accurately predict the risk of postoperative morbidity in older patients undergoing oncosurgery, including those with gynecologic malignancy (Anic et al 2022;Cioli Puviani et al 2023). In addition to CGA, CCI is a widely accepted index in clinical trials which is associated with short-term risk of mortality (Charlson et al 1987;Charlson et al 2022).…”