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Modified Frailty Index Predicts Morbidity and Mortality After Pancreaticoduodenectomy
Harveshp Mogal*1, Rebecca Dobson1, Nora Fino2, Russell Howerton1, Perry Shen1, Clancy J. Clark1
1General Surgery, Wake Forest Baptist Health, Winston Salem, NC; 2Public Health Sciences, Wake Forest Baptist Health, Winston Salem, NC
Introduction
Pancreatic cancer is a disease of older adults who may present with limited physiologic reserve. We hypothesized that a frailty index can predict postoperative outcomes after pancreaticoduodenectomy.
Methods
All patients who underwent pancreaticoduodenectomy were identified in the 2005-2012 NSQIP Participant Use File. Patients undergoing emergency procedures, ASA 5, or diagnosed with preoperative sepsis were excluded. A modified Frailty Index (mFI) was defined by 11 variables within NSQIP previously used for the Canadian Study of Health and Aging-Frailty Index. mFI score of 0.27 or more was defined as high mFI. Univariate and multiple variable analyses were performed to evaluate postoperative outcomes.
Results
9986 patients (age 65+/-12, 48.8% female) underwent pancreaticoduodenectomy with 6.4% (n= 637) having a high mFI (>=0.27). Increasing mFI was associated with higher prevalence of postoperative morbidity (p < 0.001) and 30-day mortality (p <0.001). On univariate analysis, high mFI was associated with increased morbidity (OR 1.68, 1.43-1.97 95% CI, p <0.001) and 30-day mortality (OR 2.45, 1.74-3.45 95% CI, p < 0.001). After adjusting for age, sex, ASA, albumin < 3, and BMI, high mFI remained an independent preoperative predictor of postoperative morbidity (OR 1.42, 1.15-1.75 95% CI, p = 0.001) and 30-day mortality (OR 1.54, 1.05-2.25 95% CI, p 0.027).
Conclusions
High modified Frailty Index is associated with postoperative morbidity and mortality after pancreaticoduodenectomy and can aid in preoperative risk stratification.
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