Modified frailty index predicts high-risk patients for readmission after colorectal surgery for cancer

Tatar, Cihad; Benlice, Çiğdem; Delaney, Conor P.; Holubar, Stefan D.; Líška, Dávid; Steele, Scott R.; Görgün, Emre

doi:10.1016/j.amjsurg.2019.11.016

Cited by 33 publications

(29 citation statements)

References 22 publications

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“…However, observational studies on rectal cancer focused on the prognostic value of frailty assessment without examining its use to tailor the management plan. They found that frailty, but not age, is an independent risk factor for mortality and morbidity [ 56 – 58 ] and re-admissions after rectal cancer surgery [ 59 ], radiotherapy [ 60 ], and palliative chemotherapy for metastatic disease [ 61 ].…”

Section: Resultsmentioning

confidence: 99%

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

et al. 2021

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Background and aims Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts’ consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. Methods The discussion among the steering group of clinical experts and methodologists from the societies’ expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020–January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. Conclusions The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.

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Section: Resultsmentioning

confidence: 99%

Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

et al. 2021

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“…reported that a lower frailty scale is an independent risk factor for overall survival in an older patient with gastric cancer who underwent laparoscopic gastrectomy 24 . Furthermore, clinical frailty is a predictor of severe postoperative complications in patients with colorectal cancer, 23 and the frailty index correlates with readmission in these patients 25 …”

Section: Discussionmentioning

confidence: 99%

Efficacy of preoperative frailty assessment in patients with gastrointestinal disease

Kameyama

Sakata

Hanyu

et al. 2021

Geriatrics Gerontology Int

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Aim The role of preoperative frailty assessment in patients with gastrointestinal (GI) disease remains unclear. This study aimed to clarify the relationship between frailty and postoperative outcomes in patients with GI disease. Methods This study investigated 42 patients (aged ≥65 years) with GI disease who underwent abdominal surgery. The frailty status was analyzed using the Japanese version of the Cardiovascular Health Study criteria. We also investigated postoperative outcomes. Results Of the 42 patients, seven (16.7%) were robust, 24 (57.1%) were prefrail and 11 (26.2%) were frail. Postoperative complications were observed in 45.5% and 63.6% of prefrail and frail patients, respectively, whereas no complications were found in robust patients (P = 0.026). The median hospital stay was 15, 19.5 and 27 days in robust, prefrail and frail patients, respectively (P < 0.01). Conclusion Preoperative frailty status based on the Japanese version of the Cardiovascular Health Study criteria is associated with postoperative complication incidence and hospital stay extension in patients with GI disease. Geriatr Gerontol Int 2021; ••: ••–••.

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“… 34 Nevertheless, mFI could be at least a useful adjunct to predict pulmonary infection in elderly GC patients undergoing radical gastrectomy. Without a doubt, major abdominal surgery is a great challenge for the physiological reserve of elderly patients 21 and the result that higher mFI correlate with increased risk of pulmonary infection is not surprising. In recent years, the predictive role of mFI for postoperative complications has attracted a lot of attention.…”

Section: Discussionmentioning

confidence: 99%

“… 19 Moreover, mFI was also an effective predictor of mortality in patients with brain tumor 20 and readmission after colorectal surgery for high-risk patients. 21 However, the correlation between pulmonary infection and mFI remains unknown. This study was designed to investigate the predictive value of mFI for pulmonary infection in elderly GC subjects undergoing radical gastrectomy.…”

Section: Introductionmentioning

confidence: 99%

Modified Frailty Index Independently Predicts Postoperative Pulmonary Infection in Elderly Patients Undergoing Radical Gastrectomy for Gastric Cancer

Meng¹,

Zhao²,

Yong³

2021

CMAR

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Background Pulmonary infection is one of the most common postoperative complications after radical gastrectomy for gastric cancer (GC) and is associated with a poorer prognosis. This study aimed to investigate potential predictive factors for pulmonary infection in elderly GC patients. Methods This study retrospectively enrolled 346 elderly GC patients undergoing elective radical gastrectomy between January 2017 and December 2020. Pulmonary infection within postoperative 30 days was set as the primary observational endpoint. The baseline demographic, clinicopathological, and laboratory data were compared between patients with or without pulmonary infection. ROC curves were plotted to evaluate the cut-off and predictive values of factors. Binary univariate and multivariate logistic regression analyses were employed to determine risk factors for postoperative pulmonary infection. Results Of the enrolled 346 patients, pulmonary infection was observed in 51 patients within postoperative 30 days, with an incidence of 14.7%. mFI was a significant predictor for pulmonary infection by ROC curve analysis (AUC: 0.770, P < 0.001). Moreover, preoperative mFI was the only independent risk factor for pulmonary infection (OR: 2.72, 95% CI: 2.02–3.31, P = 0.011) by univariate and multivariate logistic regression analyses. Conclusion Our study indicates that mFI independently predicts pulmonary infection in elderly GC patients.

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Modified frailty index predicts high-risk patients for readmission after colorectal surgery for cancer

Cited by 33 publications

References 22 publications

Efficacy of preoperative frailty assessment in patients with gastrointestinal disease

Modified Frailty Index Independently Predicts Postoperative Pulmonary Infection in Elderly Patients Undergoing Radical Gastrectomy for Gastric Cancer

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