Frailty index predicts severe complications in gynecologic oncology patients

Uppal, Siddharth; Hartenbach, Ellen M.; Barroilhet, Lisa; Al-Niaimi, Ahmed; Spencer, Ryan; Kushner, David M.; Rice, L.W.; Rose, Stephen L.

doi:10.1016/j.ygyno.2014.03.083

Cited by 11 publications

(18 citation statements)

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“…In an analysis on patients with gynecological malignancy included in the National Surgical Quality Improvement Program, mFI was predictive of critical care support and 30-day mortality after gynecological cancer surgery. 13 We have chosen mFI as tool to stratify elderly patients in the present study. The mFI was less than 4 (low frailty) in 70.5% of our patients and greater than or equal to 4 (high frailty) in 29.5%.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index

Ferrero¹,

Fuso²,

Tripodi³

et al. 2017

Int J Gynecol Cancer

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Section: Discussionmentioning

confidence: 99%

“…9 The Modified Frailty Index (mFI) uses 11 variables derived from the Canadian Study of Health and Aging Frailty Index and has been validated in several surgical specialties. 13 In the present retrospective study, we assessed the predictive value of age and mFI on the treatment results of primary EOC patients aged 70 years or older.…”

mentioning

confidence: 99%

Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index

Ferrero¹,

Fuso²,

Tripodi³

et al. 2017

Int J Gynecol Cancer

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“…The ACS NSQIP calculator does not include laboratory values that surgeons may not have available at the time of the preoperative counseling visit. Thus, serum albumin level is not included as a preoperative variable, although it has been identified as a predictor of postoperative morbidity in other studies[12, 13]. Lastly, since the calculator performed only marginally better in patients without disseminated cancer, it is possible that under representation of gynecologic procedures in the initial model rather than cancer-specific variables may account for the difference in performance.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the performance of the ACS NSQIP surgical risk calculator in gynecologic oncology patients undergoing laparotomy

Rivard

Nahum

Slagle

et al. 2016

Gynecologic Oncology

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Objective The objective of this study was to evaluate the ability of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) surgical risk calculator to predict complications in gynecologic oncology patients undergoing laparotomy. Methods A chart review of patients who underwent laparotomy on the gynecologic oncology service at a single academic hospital from January 2009 to December 2013 was performed. Preoperative variables were abstracted and NSQIP surgical risk scores were calculated. The risk of any complication, serious complication, death, urinary tract infection, venous thromboembolism, cardiac event, renal complication, pneumonia and surgical site infection were correlated with actual patient outcomes using logistic regression. The c-statistic and Brier score were used to calculate the prediction capability of the risk calculator. Results Of the 1,094 patients reviewed, the majority were <65 years old (70.9%), independent (95.2%), ASA class 1-2 (67.3%), and overweight or obese (76.1%). Higher calculated risk scores were associated with an increased risk of the actual complication occurring for all events (p<0.05). The calculator performed best for predicting death (c-statistic=0.851, Brier=0.008) and cardiac complications (c-statistic=0.708, Brier=0.011). The calculator did not accurately predict most complications. Conclusions The NSQIP surgical risk calculator adequately predicts specific serious complications, such as postoperative death and cardiac complications. However, the overall performance of the calculator was worse for gynecologic oncology patients than reported in general surgery patients. A tailored prediction model may be needed for this patient population.

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“…While chronologic age has been a good predictor of adverse postoperative outcomes following surgeries in various specialties, studies have identified frailty as a more accurate predictor of adverse postoperative outcomes in cohorts of patients undergoing gynecological oncology and bariatric surgery [15, 16]. Therefore, a frailty index is an objective measure that could be used for peri-operative risk stratification.…”

Section: 1 Introductionmentioning

confidence: 99%

Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy

Chappidi

Kates

Patel

et al. 2016

Urologic Oncology: Seminars and Original Investigations

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Objective To investigate the modified frailty index (mFI) as a pre-operative predictor of post-operative complications following radical cystectomy in bladder cancer patients. Materials and Methods Patients undergoing radical cystectomy (RC) were identified from the National Surgical Quality Improvement Program (NSQIP) participant use files (2011-2013). The mFI was defined in prior studies with 11 variables based on mapping the Canadian Study of Health and Aging Frailty Index to NSQIP comorbidities and activities of daily living (ADL)s. Modified frailty index groups were determined by the number of risk factors per patient (0, 1, 2, ≥3). Univariate, χ2, independent sample t-test, and logistic regression analyses were performed when appropriate. A sensitivity analysis was performed to determine the mFI value at which Clavien 4 and 5 complications would reach significance. Results Of the 2679 cystectomy patients identified, 31% percent of patients had a mFI of 0, 44% had a mFI of 1, 21% had a mFI of 2, and 4% had a mFI ≥ 3. Overall, 59% of patients experienced a Clavien complication. When stratified at a cutoff of mFI >=2, the overall complication rate was not different (61.7% vs. 58.3%, p=0.1319), but the mFI2 or greater group had a significantly higher rate of Clavien grade 4 or 5 complications (14.6% vs. 8.3%, p<0.001) and overall mortality rate (3.5% vs. 1.8%, p=0.0128) in the 30-day post-operative period. The multivariate logistic regression model showed independent predictors of Clavien grade 4 or 5 complications were age >80 years old (OR, 1.58 [1.11-2.27]), mFI2 (odds ratio [OR], 1.84 [1.28-2.64]), and mFI3 (OR, 2.58 [1.47-4.55]). Conclusions Among patients undergoing radical cystectomy, the mFI can identify those patients at greatest risk for severe complications and mortality. Given that bladder cancer is increasing in prevalence particularly among the elderly, pre-operative risk stratification is crucial to inform decision making about surgical candidacy.

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Frailty index predicts severe complications in gynecologic oncology patients

Cited by 11 publications

References 0 publications

Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index

Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index

Evaluation of the performance of the ACS NSQIP surgical risk calculator in gynecologic oncology patients undergoing laparotomy

Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy

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