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Can modified frailty index predict postoperative complication after lung cancer surgery?

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Abstract

Purpose

The impact of the modified frailty index (mFI) on postoperative complications after lung cancer surgery was investigated.

Methods

Patients who underwent lung cancer surgery in 2017 were included. 30-day postoperative mortality and morbidity were evaluated according to their Clavien–Dindo classification. mFI values are presented as the sum of values of 11 included items. Logistic regression was used to assess the effect of mFI on postoperative severe complication incidence.

Results

Among 190 patients considered, severe postoperative complications (Grade 3 or more) were observed in 30 (16%). No patients died within 30 days of surgery. The incidence of severe complications was 3.6% in patients with mFI of 0, 16.2% in patients with mFI of 1, 23.4% in patients with mFI of 2, and 31.6% in patients with mFI of 3 or more, and was correlated with the grade of mFI. Univariate and multivariate analyses showed that the high mFI was significantly predictive of postoperative complications. Frail patients of mFI ≥ 2 were at 3.0-fold greater risk of severe complications than non-frail patients of mFI 0 or 1.

Conclusion

mFI was associated with morbidity after lung cancer surgery. Preoperative frailty assessment and appropriate intervention to frail patients would be required to improve postoperative outcomes.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.

    Article  CAS  PubMed  Google Scholar 

  2. Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. Sci World J. 2001;1:323–36.

    Article  CAS  Google Scholar 

  3. Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol Biol Sci. 2007;62:711–7.

    Article  Google Scholar 

  4. 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;183:104–10.

    Article  PubMed  Google Scholar 

  5. 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;183:40–6.

    Article  PubMed  Google Scholar 

  6. Hirpara DH, Kidane B, Rogalla P, Cypel M, de Perrot M, Keshavjee S, et al. Frailty assessment prior to thoracic surgery for lung or esophageal cancer: a feasibility study. Support Care Cancer. 2019;27:1535–40.

    Article  PubMed  Google Scholar 

  7. Pandit V, Khan M, Martinez C, Jehan F, Zeeshan M, Koblinski J, et al. A modified frailty index predicts adverse outcomes among patients with colon cancer undergoing surgical intervention. Am J Surg. 2018;216:1090–4.

    Article  PubMed  Google Scholar 

  8. Osaki T, Saito H, Shimizu S, Murakami Y, Miyatani K, Matsunaga T, et al. Modified frailty index is useful in predicting nonhome discharge in elderly patients with gastric cancer who undergo gastrectomy. World J Surg. 2020;44:3837–44.

    Article  PubMed  Google Scholar 

  9. Ali TZ, Lehman EB, Aziz F. Modified frailty index can be used to predict adverse outcomes and mortality after lower extremity bypass surgery. Ann Vasc Surg. 2018;46:168–77.

    Article  PubMed  Google Scholar 

  10. Chambers LM, Chalif J, Yao M, Chichura A, Morton M, Gruner M, et al. Modified frailty index predicts postoperative complications in women with gynecologic cancer undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Gynecol Oncol. 2021;162:368–74.

    Article  PubMed  Google Scholar 

  11. Kweh BTS, Lee HQ, Tan T, Tew KS, Leong R, Fitzgerald M, et al. Risk stratification of elderly patients undergoing spinal surgery using the modified frailty index. Glob Spine J. 2023;13:457–65.

    Article  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications; a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Haruki T, Yurugi Y, Wakahana M, Matsuoka Y, Miwa K, Araki K, et al. Simplified comorbidity score for elderly patients undergoing thoracoscopic surgery for lung cancer. Surg Today. 2017;47:718–25.

    Article  PubMed  Google Scholar 

  14. Klidjian AM, Foster KJ, Kammerling RM, Cooper A, Karran SJ. Relation of anthropometric and dynamometric variables to serious postoperative complications. Br Med J. 1980;281:899–901.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Afilalo J, Eisenberg MJ, Morin JF, Bergman H, Monette J, Noiseux N, et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010;56:1668–76.

    Article  PubMed  Google Scholar 

  16. Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2009;48:78–83.

    Article  PubMed  Google Scholar 

  17. Sündermann S, Dademasch A, Praetorius J, Kempfert J, Dewey T, Falk V, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg. 2011;39:33–7.

    Article  PubMed  Google Scholar 

  18. Hanada M, Yamauchi K, Miyazaki S, Oyama Y, Yanagita Y, Sato S, et al. Short-physical performance battery (SPPB) score is associated with postoperative pulmonary complications in elderly patients undergoing lung resection surgery: a prospective multicenter cohort study. Chron Respir Dis. 2020. https://doi.org/10.1177/1479973120961846.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Saxton A, Velanovich V. Preoperative frailty and quality of life as predictors of postoperative complications. Ann Surg. 2011;253:1223–9.

    Article  PubMed  Google Scholar 

  20. Partridge JSL, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing. 2012;41:142–7.

    Article  PubMed  Google Scholar 

  21. 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;226:173-181.e8.

    Article  PubMed  Google Scholar 

  22. Lee ACH, Lee SM, Ferguson MK. Frailty is associated with adverse postoperative outcomes after lung cancer resection. JTO Clin Res Rep. 2022;3: 100414.

    PubMed  PubMed Central  Google Scholar 

  23. Karunungan KL, Hadaya J, Tran Z, Sanaiha Y, Mandelbaum A, Revels SL, et al. Frailty is independently associated with worse outcomes after elective anatomic lung resection. Ann Thorac Surg. 2021;112:1639–46.

    Article  PubMed  Google Scholar 

  24. Saji H, Ueno T, Nakamura H, Okumura N, Tsuchida M, Sonobe M, et al. A proposal for a comprehensive risk scoring system for predicting postoperative complications in octogenarian patients with medically operable lung cancer: JACS1303. Eur J Cardio Thorac Surg. 2018;53:835–41.

    Article  Google Scholar 

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Acknowledgements

We thank Editage (www.editage.com) for English language editing. The authors have nothing to disclose regarding the sources of funding for this study.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Hironobu Wada, Hidemi Suzuki, Yuichi Sakairi, Kazuhisa Tanaka, Yuki Sata, Takahide Toyoda, Terunaga Inage, Yukiko Matsui & Ichiro Yoshino

  2. Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, 286-8686, Japan

    Hironobu Wada & Ichiro Yoshino

Authors
  1. Hironobu Wada
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  2. Hidemi Suzuki
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  4. Kazuhisa Tanaka
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  5. Yuki Sata
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  8. Yukiko Matsui
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  9. Ichiro Yoshino
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Correspondence to Hidemi Suzuki.

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Wada, H., Suzuki, H., Sakairi, Y. et al. Can modified frailty index predict postoperative complication after lung cancer surgery?. Gen Thorac Cardiovasc Surg 72, 176–182 (2024). https://doi.org/10.1007/s11748-023-01962-3

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  • DOI: https://doi.org/10.1007/s11748-023-01962-3

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