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The Impact of Frailty on Patients Undergoing Liver Resection for Colorectal Liver Metastasis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The aim of this study is to assess the impact of frailty on short-term outcomes after hepatectomy for colorectal liver metastasis (CRLM).

Methods

Patients were identified using the National Surgical Quality Improvement Program (NSQIP). Patients were divided into 3 categories using the 5-item Modified Frailty Index (mFI).

Results

There were 5230 patients included. 52%, 35%, and 13% had mFI scores of 0, 1, and ≥ 2 respectively. Patients with a ≥ 2 mFI score were more likely to experience minor complication (OR 1.34, 95% CI 1.06–1.69), major complication (OR 1.56, 95% CI 1.15–2.12), readmission (OR 1.55, 95% CI 1.12–2.14), unfavorable discharge (OR 2.48, 95% CI 1.62–3.80), 30-day mortality (OR 3.02, 95% CI 1.02–8.95), prolonged length of stay (OR 1.47, 95% CI 1.18–1.83), and bile leak (OR 1.51, 95% CI 1.02–2.24).

Conclusion

Frailty is associated with increased post-operative complications. The 5-item mFI can guide risk stratification, optimization, and counseling.

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References

  1. Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a Predictor of Surgical Outcomes in Older Patients. J Am Coll Surg. 2010;210(6):901-908. https://doi.org/10.1016/j.jamcollsurg.2010.01.028

    Article  PubMed  Google Scholar 

  2. Saxton A, Velanovich V. Preoperative frailty and quality of life as predictors of postoperative complications. Ann Surg. 2011;253(6):1223-1229. https://doi.org/10.1097/SLA.0b013e318214bce7

    Article  PubMed  Google Scholar 

  3. Chimukangara M, Helm MC, Frelich MJ, et al. A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surg Endosc. 2017;31(6):2509-2519. https://doi.org/10.1007/s00464-016-5253-7

    Article  PubMed  Google Scholar 

  4. Richards CH, Platt JJ, Anderson JH, McKee RF, Horgan PG, McMillan DC. The impact of perioperative risk, tumor pathology and surgical complications on disease recurrence following potentially curative resection of colorectal cancer. Ann Surg. 2011;254(1):83-89. https://doi.org/10.1097/SLA.0b013e31821fd469

    Article  PubMed  Google Scholar 

  5. Chang GJ, Kaiser AM, Mills S, Rafferty JF, Buie WD. Practice parameters for the management of colon cancer. Dis Colon Rectum. 2012;55(8):831-843. https://doi.org/10.1097/DCR.0b013e3182567e13

    Article  PubMed  Google Scholar 

  6. Pandit V, Khan M, Martinez C, et al. A modified frailty index predicts adverse outcomes among patients with colon cancer undergoing surgical intervention. Am J Surg. 2018;216(6):1090-1094. https://doi.org/10.1016/j.amjsurg.2018.07.006

    Article  PubMed  Google Scholar 

  7. Liu W, Zhou JG, Sun Y, Zhang L, Xing BC. The role of neoadjuvant chemotherapy for resectable colorectal liver metastases: A systematic review and meta-analysis. Oncotarget. 2016;7(24):37277–37287. https://doi.org/10.18632/oncotarget.8671

  8. Wahl TS, Graham LA, Hawn MT, et al. Association of the modified frailty index with 30-day surgical readmission. JAMA Surg. 2017;152(8):749-757. https://doi.org/10.1001/jamasurg.2017.1025

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tsiouris A, Hammoud ZT, Velanovich V, Hodari A, Borgi J, Rubinfeld I. A modified frailty index to assess morbidity and mortality after lobectomy. J Surg Res. 2013;183(1):40-46. https://doi.org/10.1016/j.jss.2012.11.059

    Article  PubMed  Google Scholar 

  10. Gani F, Canner JK, Pawlik TM. Use of the modified frailty index in the American college of surgeons national surgical improvement program database: Highlighting the problem of missing data. JAMA Surg. 2017;152(2):205-207. https://doi.org/10.1001/jamasurg.2016.3479

    Article  PubMed  Google Scholar 

  11. Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data. J Am Coll Surg. 2018;226(2):173-181.e8. https://doi.org/10.1016/j.jamcollsurg.2017.11.005

    Article  PubMed  Google Scholar 

  12. Chen SY, Stem M, Cerullo M, et al. The Effect of Frailty Index on Early Outcomes after Combined Colorectal and Liver Resections. J Gastrointest Surg. 2018;22(4):640-649. https://doi.org/10.1007/s11605-017-3641-5

    Article  PubMed  Google Scholar 

  13. AL‐Khamis A, Warner C, Park J, et al. Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study. Color Dis. 2019;21(10):1192–1205. https://doi.org/10.1111/codi.14725

  14. Balzan S, Belghiti J, Farges O, et al. The “50–50 criteria” on postoperative day 5: An accurate predictor of liver failure and death after hepatectomy. In: Annals of Surgery. Vol 242. Ann Surg; 2005:824–829. https://doi.org/10.1097/01.sla.0000189131.90876.9e

  15. Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I. Accumulating deficits model of frailty and postoperative mortality and morbidity: Its application to a national database. J Surg Res. 2013;183(1):104-110. https://doi.org/10.1016/j.jss.2013.01.021

    Article  PubMed  Google Scholar 

  16. Fried LP, Tangen CM, Walston J, et al. Frailty in Older Adults: Evidence for a Phenotype. Journals Gerontol Ser A Biol Sci Med Sci. 2001. https://doi.org/10.1093/gerona/56.3.m146

    Article  Google Scholar 

  17. Piccirillo JF, Feinstein AR. Clinical symptoms and comorbidity: Significance for the prognostic classification of cancer. Cancer. 1996. https://doi.org/10.1002/(SICI)1097-0142(19960301)77:5<834::AID-CNCR5>3.0.CO;2-E

    Article  PubMed  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40(5):373-383. https://doi.org/10.1016/0021-9681(87)90171-8

    Article  CAS  PubMed  Google Scholar 

  19. McDowell I, Hill G, Lindsay J, et al. Canadian Study of Health and Aging: Study methods and prevalence of dementia. CMAJ. 1994;150(6):899-912.

    Google Scholar 

  20. Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale [4]. Age Ageing. 2006. https://doi.org/10.1093/ageing/afl041

    Article  PubMed  PubMed Central  Google Scholar 

  21. Obeid NM, Azuh O, Reddy S, et al. Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program: Exploring frailty and aggressive laparoscopic approaches. J Trauma Acute Care Surg. 2012;72(4):878-883. https://doi.org/10.1097/TA.0b013e31824d0f70

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Arizona College of Medicine, Tucson, AZ, USA

    Jacqueline Dauch, Mohammad Hamidi, Amanda K. Arrington, Catherine L. O’Grady, Chiu-Hsieh Hsu, Bellal Joseph, Taylor S. Riall & Mohammad Khreiss

  2. Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, USA

    Mohammad Khreiss

Authors
  1. Jacqueline Dauch
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  2. Mohammad Hamidi
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  3. Amanda K. Arrington
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  4. Catherine L. O’Grady
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  5. Chiu-Hsieh Hsu
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  6. Bellal Joseph
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  7. Taylor S. Riall
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  8. Mohammad Khreiss
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Contributions

Study Design and Conception: JD, MH, AA, BJ, TR, MK

Data Acquisition: JD, CO, CH

Statistical Analysis: JD, CO, CH

Manuscript Writing: JD, MH, AA, CO, CH, BJ, TR, MK

Critical Revision: JD, MH, AA, CO, CH, BJ, TR, MK

Corresponding author

Correspondence to Mohammad Khreiss.

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Disclosure

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Dauch, J., Hamidi, M., Arrington, A.K. et al. The Impact of Frailty on Patients Undergoing Liver Resection for Colorectal Liver Metastasis. J Gastrointest Surg 26, 608–614 (2022). https://doi.org/10.1007/s11605-021-05149-0

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  • DOI: https://doi.org/10.1007/s11605-021-05149-0

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