Value of Geriatric Frailty and Nutritional Status Assessment in Predicting Postoperative Mortality in Gastric Cancer Surgery

Tegels, Juul J. W.; Maat, Michiel F.G. de; Hulsewé, Karel W. E.; Hoofwijk, A. G. M.; Stoot, Jan H.M.B.

doi:10.1007/s11605-013-2443-7

Cited by 98 publications

(80 citation statements)

References 30 publications

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“…Most studies were observational (23 of 35) with a total of 1 153 684 patients available for the analysis. Cohorts were composed of patients undergoing lower gastrointestinal (GI) surgery (10 studies), upper GI surgery (6), mixed GI surgery (4), gynaecological surgery (6), urological surgery (4) and mixed abdominal surgery (6) ( Table 1)1 12, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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“…The baseline characteristics of the remaining 63 patients are displayed in Table 1 and results of the GFI in Supplementary Table 2. Median age of included patients was 75 years (range 66-92) and 35% were women; 65% of patients were married, 27% was widower and 8% was unmarried. Median Charlson comorbidity index was 1 (range 0-6) and patients used a median of eight types of prescription medications (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Median eGFR at inclusion was 16 mL/min (range 5-34).…”

Section: Resultsmentioning

confidence: 99%

“…13,14 In geriatric oncology, several frailty screening tools are used to help identifying vulnerable patients, 15 including the GFI. 16,17 As patients with advanced renal failure experience a symptom burden and impairment of quality of life similar to that of patients with terminal malignancy, such tools could perhaps also be used to screen for potentially frail elderly among geriatric ESRD patients. 18 In this study, we aimed to assess whether the GFI can be used to distinguish fit older ESRD patients, likely able to tolerate and benefit from dialysis, from frail older patients who need further evaluation with a geriatrician's comprehensive assessment in a daily nephrology outpatient setting.…”

Section: Introductionmentioning

confidence: 99%

Groningen frailty indicator in older patients with end-stage renal disease

et al. 2015

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Background: Currently over 55% of end-stage renal disease (ESRD) patients are aged 60 years and patients 475 years represent the fastest growing segment of the dialysis population. We aimed to assess whether the Groningen frailty indicator (GFI) can be used to distinguish fit older ESRD patients, likely able to tolerate and benefit from dialysis, from frail older patients who need further evaluation with a geriatrician's comprehensive assessment. Methods: All patients aged 65 years visiting the pre-dialysis unit at the Gelre hospital between 2007 and 2013 were included and underwent the GFI (n ¼ 65). Patients with GFI 4 (frail) were referred for geriatric consultation (n ¼ 13). Results of the GFI and nephrologists' evaluation were compared with geriatrician's assessment. Survival rates and outcomes after one year of follow up were recorded. Results: Twenty patients (32%) were identified as frail. Of the problems identified by the geriatrician in 13 patients, 55% were not reported in the nephrologists' notes. The first year after inclusion, 30% of patients with a GFI 4 died, compared to 9% of fit patients (p ¼ 0.04). Moreover, 90% of frail patients had been hospitalized one or more times, compared to 53% in the fit group (p ¼ 0.005). Conclusion: Although the GFI can be a useful instrument to identify ESRD patients at risk, both the GFI and the nephrologists' assessment failed to identify specific geriatric impairments. Further research is needed to develop a specific frailty indicator for ESRD patients and to determine the value and effect of a comprehensive geriatric assessment in ESRD patients.

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“…This questionnaire was used in a retrospective study to evaluate frailty assessment as a predictor for adverse outcome after gastric cancer surgery. In this recent study, incorporating 180 patients, increased GFI was significantly associated with postoperative morbidity and in-hospital mortality [30] . Prehabilitation A novel strategy for improving outcomes after surgery is by preoperatively correcting the reduced functional, nutritional, physical and neurophysiological state of patients: prehabilitation [45] .…”

Section: Mustmentioning

confidence: 87%

“…Increased scores are associated with more complications and increased length-of-stay [29] . A recently published study in which SNAQ was used to evaluate risks of adverse postoperative events after gastric cancer surgery showed that SNAQ ≥ 1 was associated with increased severe complications (i.e., Clavien-Dindo grade ≥ 3a, 35.7% vs 17.7%, P = 0.02) and in-hospital mortality (OR = 5.1, 95%CI: 1.01-23.8, P = 0.04) [30] . The detection of nutritional depletion is important, especially with…”

Section: Frailtymentioning

confidence: 99%

Improving the outcomes in gastric cancer surgery

Tegels¹,

Maat²,

Hulsewé³

et al. 2014

WJG

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Value of Geriatric Frailty and Nutritional Status Assessment in Predicting Postoperative Mortality in Gastric Cancer Surgery

Abstract: This study shows a significant relationship between gastric cancer surgical mortality and geriatric frailty as well as nutritional status using a simple questionnaire. This may have implications in preoperative decision making in selecting patients who optimally benefit from surgery.

Cited by 98 publications

References 30 publications

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Groningen frailty indicator in older patients with end-stage renal disease

Improving the outcomes in gastric cancer surgery

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