Risk Stratification Tool for Predicting Postoperative Outcomes in Patients Undergoing Esophagectomy: A Prospective Study

Abstract

Purpose Frailty, a clinical syndrome characterized by a reduced physiological reserve and decreased resistance to stressors, is extremely common in oncology patients. Given that esophagectomy is associated with significant postoperative adverse outcomes, the early identification of high-risk patients is critical. This study compared the utility of the Modified 5-Factor Frailty Index (mFI-5) and the Modified Charlson Comorbidity Index (mCCI) in predicting postoperative outcomes in patients undergoing esophagectomy. Method We reviewed the records of patients who underwent esophagectomy between 2019 and 2022. Two validated risk stratification tools measured the burden of comorbidity: mFI-5 and mCCI. The primary outcomes included a prolonged postoperative hospital stay and major and minor postoperative complications. Result A total of 359 patients were included (mean age 63.1 ± 8.6 years; 74.4% were males). The length of postoperative hospital stay was 30.0 (IQR 25.0,39.5) days, with 37 patients (10.3%) experiencing major postoperative complications and 192 patients (53.5%) experiencing minor postoperative complications. In multivariate analysis, mCCI remained a significant predictor of major postoperative complications (OR = 1.52, 95% CI 1.01–2.3, p = 0.046), but was no longer a significant predictor of prolonged postoperative hospital stay or minor complications. In addition, the mFI-5 score was no longer a significant predictor of any of the three postoperative outcomes. Conclusion This is the first study to compare the utility of the mFI-5 and mCCI in predicting adverse postoperative outcomes in patients undergoing esophagectomy. Our findings suggest that mCCI is a valid predictor of major complications in this patient group, whereas the role of mFI-5 is limited. This should be further investigated in a prospective multicenter cohort study.