Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients

Vermillion, Sarah A.; Hsu, Fang‐Chi; Dorrell, Robert; Shen, Perry; Clark, Clancy J.

doi:10.1002/jso.24617

Cited by 90 publications

(69 citation statements)

References 52 publications

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“…Vermillion et al . reported 11‐mFI to be an independent predictor of major complications, prolonged LOS and mortality in surgical oncology patients. When the impact of an incremental increase in mFI score in open, emergent colectomies was analysed, Congiusta et al .…”

Section: Discussionmentioning

confidence: 99%

“…Chen et al [25] examined the impact of 5-mFI scores on 1928 patients who had combined liver and colon resections and reported mFI ≥ 2 to be significantly associated with increased odds of overall and serious morbidity. Vermillion et al [18] reported 11-mFI to be an independent predictor of major complications, prolonged LOS and mortality in surgical oncology patients. When the impact of an incremental increase in mFI score in open, emergent colectomies was analysed, Congiusta et al [23] found mortality, serious morbidity and reoperation to be significantly increased with each increase in mFI score.…”

Section: Discussionmentioning

confidence: 99%

“…The CSHA‐FI recognizes 70 potential deficits that are easily identifiable during a patient's preoperative assessment. A frailty score is generated by calculating the proportion of potential deficits present to the total potential deficits that are evaluated . In 2013, a modified frailty index (mFI) was derived by matching the CSHA‐FI to 11 variables collected by the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) .…”

Section: Introductionmentioning

confidence: 99%

“…A frailty score is generated by calculating the proportion of potential deficits present to the total potential deficits that are evaluated . In 2013, a modified frailty index (mFI) was derived by matching the CSHA‐FI to 11 variables collected by the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) . Similar to CSHA‐FI, the 11‐item mFI (11‐mFI) was proven to be a valid predictor of postoperative outcomes .…”

Section: Introductionmentioning

confidence: 99%

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Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study

et al. 2019

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Aim Frailty is defined as a decrease in physiological reserve with increased risk of morbidity following significant physiological stressors. This study examines the predictive power of the five‐item modified frailty index (5‐mFI) in predicting outcomes in colorectal surgery patients. Methods The American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2011 to 2016 to determine the predictive power of 5‐mFI in patients who had colorectal surgery. Results Of 295 490 patients, 45.8% had a score of 0, 36.2% had a score of 1 and 18% had a score of ≥ 2. On univariate analysis, frailer patients had significantly greater incidences for overall morbidity, serious morbidity, mortality, prolonged length of hospital stay, discharge to a facility other than home, reoperation and unplanned readmission. These findings were consistent on multivariate analysis where the frailest patients had greater odds of postoperative overall morbidity (OR 1.39; 95% CI 1.35–1.43), serious morbidity (OR 1.39; 95% CI 1.33–1.45), mortality (OR 2.00; 95% CI 1.87–2.14), prolonged length of hospital stay (OR 1.24; 95% CI 1.20–1.27), discharge destination to a facility other than home (OR 2.80; 95% CI 2.70–2.90), reoperation (OR 1.17; 95% CI 1.11–1.23) and unplanned readmission (OR 1.31; 95% CI 1.26–1.36). Weighted kappa statistics showed strong agreement between the 5‐mFI and 11‐mFI (kappa = 0.987, P < 0.001). Conclusions The 5‐mFI is a valid and easy to use predictor of 30‐day postoperative outcomes after colorectal surgery. This tool may guide the surgeon to proactively recognize frail patients to instigate interventions to optimize them preoperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study

et al. 2019

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“…Frailty screening is one example of an intervention that predicts post-op complications, length of stay, discharge to a skilled nursing facility, and mortality. 37,38 Assessing frailty can help patients and clinicians make informed decisions, including not to perform surgery on high-risk elderly patients and ensuring pre-and post-op supportive care for those who do undergo surgery. Specific research gaps for elderly surgical patients include communication, such as preoperative advance care planning and postoperative decision making, to ensure treatments are aligned with patient-oriented outcomes; identifying patient-centered outcomes that are of value to patients; evaluating high-quality palliative care in surgery; and testing methods to integrate palliative care into a rescue-oriented surgical culture.…”

Section: Surgerymentioning

confidence: 99%

Research Priorities in Subspecialty Palliative Care: Policy Initiatives

Reinke

Meier

2017

Journal of Palliative Medicine

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Palliative care demonstrably improves quality of life for the seriously ill in a manner that averts preventable health crises and their associated costs. Because of these outcomes, palliative care is now broadening its reach beyond hospitals, and hospice care for those near death, to patients and their families living in the community with chronic multimorbidities that have uncertain or long expected survival. In this article, we address research needed to enable policies supportive of palliative care access and quality, including changes in regulatory, accreditation, financing, and training approaches in the purview of policy makers. Mr. K. is an 86-year-old male with multimorbidities, including severe chronic obstructive pulmonary disease, congestive heart failure, peripheral vascular disease, and atrial fibrillation requiring anticoagulation therapy. He fell in his mobile home and was unable to reach the telephone to call for help. Six hours later, his neighbor found him lying on the bedroom floor in pain and confused, and called 911. On examination, he was found to have a cold blue foot complicated by a large hematoma. The vascular surgery service was consulted to evaluate Mr. K. for revascularization or amputation. Although Mr. K. had several risk factors complicating his candidacy for general anesthesia, the team thought the benefits of surgery would outweigh the risks. Mr. K's daughter agreed to surgery telling her father "the doctors know best." Mr. K. replied "I just want to be out of pain." Six months later, Mr. K. remains in a skilled nursing facility due to post-op complications, including pneumonia, worsened confusion, and the inability to recover to enough function to live safely at home. He now suffers from depression, cognitive deficits, and social isolation. His daughter has had to take on a second job because she is struggling to pay for his continued long-term care, which costs $6000 per month. Money she had saved for her own retirement and her daughter's college tuition is already gone. In retrospect, she realizes the surgical team did not discuss the possibility of his survival with chronic debility and long-term functional dependency, nor the fact that Medicare would not pay for the care he now requires.

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Comment on “Preoperative C‐reactive protein‐to‐albumin ratio predicts long‐term outcomes in extrahepatic cholangiocarcinoma patients”

Sun

Yang³

2020

Journal of Surgical Oncology

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Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients

Abstract: mFI was associated with the incidence of postoperative complications and mortality in older surgical patients with gastrointestinal cancer.

Cited by 90 publications

References 52 publications

Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study

Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study

Research Priorities in Subspecialty Palliative Care: Policy Initiatives

Comment on “Preoperative C‐reactive protein‐to‐albumin ratio predicts long‐term outcomes in extrahepatic cholangiocarcinoma patients”

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