Preoperative risk analysis index for frailty predicts short-term outcomes after hepatopancreatobiliary surgery

Windt, Dirk J. van der; Bou‐Samra, Patrick; Dadashzadeh, Esmaeel R.; Chen, Xilin; Varley, Patrick; Tsung, Allan

doi:10.1016/j.hpb.2018.05.016

Cited by 29 publications

(23 citation statements)

References 38 publications

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“…Independent analysis of the ACS calculator has also demonstrated inaccuracies regarding its ability to reliably predict patient length of stay [ 24 ]. The Risk Analysis Index has been found to be a helpful adjunct in addition to the ACS score because of its ability to leverage patient frailty as an identifier for potential surgical prehabilitation [ 25 ]. Furthermore, use of a self-identified functionality scale was a better predictive tool for adverse outcomes when combined with the ACS calculator than the frailty phenotype [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Perioperative considerations in nonagenarians

Tecos

Kern

Foje

et al. 2020

Surgery Open Science

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Objective The nation's aging population presents novel perioperative challenges. Potential benefits of operative interventions must be scrutinized in relation to recoverable quality of life. The purpose of this study is to evaluate common risk calculators used for medical decision making in a nonagenarian patient population. Methods Retrospective medical record review was performed on patients 90 years or older who underwent operative interventions requiring anesthesia at a large academic medical center between January 1, 2013, and December 31, 2017. GraphPad 8.2.1 was used for statistical analysis. Results Significant differences were found when data were stratified by age for elective versus emergent cases (P value < .0001), ability to return to baseline function (P value  = .0062), and mortality (P value < .0001). Significant differences were found in emergent and elective cases, ability to return to baseline function, readmissions, and mortality (all P values < .0001) when stratified by American Society of Anesthesiologists score. Ability of patients to return to baseline functionality after intervention was influenced by their preintervention level of functionality (P value = .0008). American College of Surgeons and Portsmouth Physiologic and Operative Severity Score for Enumeration of Mortality and Morbidity risk calculators underestimated the need for rehabilitation and overestimated mortality for this population (all P values < .0001). Conclusion Perioperative cares of the extreme geriatric population are complex and should be approached collaboratively. Rehabilitation and postoperative assistance resources should be assessed and used fully. Input from palliative care teams should be sought appropriately. End-of-life and escalation-of-care discussions should ideally be organized prior to emergent interventions. Frailty and risk calculators should be used and considered for formal implementation into the preoperative workflow.

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Section: Discussionmentioning

confidence: 99%

Perioperative considerations in nonagenarians

Tecos

Kern

Foje

et al. 2020

Surgery Open Science

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“…Various risk prediction models are reported in diverse pathologies and surgeries to enhance resource allocation [18,34,35] . A prospective study on 162 patients undergoing hepatopancreaticobiliary surgery by van der Windt et al [36] , showed that scoring systems such as the Risk Analysis Index, was able to accurately predict post-operative outcomes in patients. The study further elaborates on the possible use of such a scoring system to identify target groups for prehabilitation to optimise outcomes.…”

Section: Target Populationmentioning

confidence: 99%

Prehabilitation in elderly patients scheduled for liver resection and protocol for Recovery Of Surgery in Elderly

Mohan¹,

Huey²,

Junnarkar³

et al. 2020

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Ageing population of first world economies pose unique challenges to surgical community. Enhanced recovery after surgery protocols and pathways do not attempt to optimize or enhance physical function of patients by customized program of physical activity. Increasingly, prehabilitation programs (PP) have gained momentum in orthopaedics, urology, colorectal surgery and hepatopancreaticobiliary surgery. Current evidence of PP in various elective surgical procedures have shown improved outcomes with minimal to none drawback or harm. There is emerging evidence of role of PP in elective liver resection. The aim of this paper is to review the basis of PP and share local multidisciplinary team protocol specifically customized to frail and elderly population-Recovery Of Surgery in Elderly.

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“…3 Frailty has been described as a state of decreased physiologic reserve, characterized by a loss of resiliency in the face of acute stress. 4 Following surgical stress, frail individuals are more likely to experience adverse health outcomes including higher rates of morbidity and mortality. 3,5 However, there is a lack of consensus regarding a precise definition of the term and as a result numerous tools with divergent criteria have been developed in an effort to quantify frailty.…”

Section: Introductionmentioning

confidence: 99%

“…6 Previous studies have identified frailty as a predictor of postoperative morbidity following liver resection with tools such as the Risk Analysis Index, Clinical Frailty Scale, and Kihon Checklist. 4,7,8 However, the use of mFI as a tool to stratify patients undergoing liver resections has yet to be extensively evaluated. As such, we sought to investigate the relationship between frailty and postoperative outcomes, specifically, the efficacy of mFI as a tool to predict postoperative complications and postoperative mortality among patients undergoing liver resection.…”

Section: Introductionmentioning

confidence: 99%

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

McKechnie

Bao

Fabbro

et al. 2020

The American Surgeon

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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.

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Preoperative risk analysis index for frailty predicts short-term outcomes after hepatopancreatobiliary surgery

Abstract: While RAI and ACS-NSQIP Risk Calculator comparatively predicted short-term outcomes after HPB surgery, RAI has been specifically designed to identify frail patients who can potentially benefit from preoperative prehabilitation interventions.

Cited by 29 publications

References 38 publications

Perioperative considerations in nonagenarians

Perioperative considerations in nonagenarians

Prehabilitation in elderly patients scheduled for liver resection and protocol for Recovery Of Surgery in Elderly

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

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