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Modified Frailty Index is Useful in Predicting Non-home Discharge in Elderly Patients with Gastric Cancer Who Undergo Gastrectomy

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Abstract

Background

Development of laparoscopic gastrectomy and the Enhanced Recovery After Surgery (ERAS) protocol enable early discharge to home of patients with gastric cancer (GC). However, a significant proportion of patients are still discharged to inpatient facilities after surgery. We aimed to identify predictive factors of non-home discharge in patients with GC who undergo gastrectomy.

Methods

We enrolled 517 patients with histopathologically confirmed diagnosis of GC who underwent gastrectomy.

Results

The number of patients with non-home discharge was 23 (4.4%), and non-home discharge was only observed in patients with GC aged ≥65 years. Patients were divided into the mFIHigh (≥0.272) and mFILow (<0.272) groups according to the cut-off value determined by ROC analysis. The mFIHigh classification was significantly more frequent in patients aged ≥75 years, who underwent either total or proximal partial gastrectomy, who underwent limited lymph node dissection, and with non-home discharge than in patients aged <75 years (p = 0.0002), those who underwent distal partial gastrectomy (p = 0.032), those who underwent standard lymph node dissection (p = 0.036), and those without non-home discharge (p = 0.0071). Multivariate analysis revealed mFI as an independent predictive indicator of non-home discharge, along with postoperative complications and surgical approach, in patients with GC aged ≥65 years. The frequency of patients with non-home discharge was significantly associated with the number of these three predictive factors in GC patients aged ≥65 years (p < 0.0001).

Conclusions

The combination of mFI, postoperative complications, and surgical approach is useful for predicting non-home discharge in patients aged ≥65 years who underwent gastrectomy for GC.

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Acknowledgements

We would like to thank Prof. Yoichi Kurosawa for his helpful comments on statics and Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, 680-0901, Japan

    Tomohiro Osaki, Shigeru Tatebe & Masahide Ikeguchi

  2. Department of Surgery, Japanese Red Cross Tottori Hospital, 117 Shotoku-cho, Tottori, 680-8517, Japan

    Hiroaki Saito & Yuki Murakami

  3. Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan

    Shota Shimizu, Kozo Miyatani, Tomoyuki Matsunaga & Yoshiyuki Fujiwara

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  1. Tomohiro Osaki
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Correspondence to Tomohiro Osaki.

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Osaki, T., Saito, H., Shimizu, S. et al. Modified Frailty Index is Useful in Predicting Non-home Discharge in Elderly Patients with Gastric Cancer Who Undergo Gastrectomy. World J Surg 44, 3837–3844 (2020). https://doi.org/10.1007/s00268-020-05691-z

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  • DOI: https://doi.org/10.1007/s00268-020-05691-z

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