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MODIFIED FRAILTY INDEX PREDICTS DISPOSITION AFTER MAJOR RESECTION FOR GASTROINTESTINAL CANCER
Rebecca M. Dodson*, Sarah Vermillion, Michael Kuncewitch, Perry Shen, Clancy J. Clark
General Surgery, Wake Forest Baptist Health, Winston Salem, NC
Introduction
Gastrointestinal (GI) cancers disproportionally affect older adults who may present with limited physiologic reserve resulting in prolonged recovery. We hypothesized that a frailty index can predict postoperative disposition after major abdominal surgery.
Methods
All patients diagnosed with a GI malignancy (esophageal, gastric, pancreatic, liver, biliary, and colorectal) who underwent curative resection were identified in the 2011 and 2012 NSQIP Participant Use Files. Patients undergoing emergency procedures, not admitted from home, 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 disposition.
Results
11,301 patients (age 64+/- 13, 46% female) underwent curative surgery for GI cancer with 4.3% (n= 482) having a high mFI (>=0.27). 61.8% (n = 6969) of patients were ASA 3/4 and 98.5% were independent prior to surgery. Postoperatively, 16.5% developed a major complication and 30-day mortality was 2.2%. 7.9% were discharged to a facility and 12.1% required readmission. High mFI was associated with increased risk of discharge to facility (OR 3.4, 95% CI 2.7-4.2, p<0.001) and readmission (OR 1.4, 95% CI 1.1-1.8, p = 0.013). After adjusting for age, race, albumin, length of operation, ASA, and cancer site, high mFI predicted discharge to facility (OR 1.8, 95% CI 1.4-2.4, p<0.001) and readmission (OR 1.5, 95% CI 1.1-2.0).
Conclusions
High modified Frailty Index is associated with increased risk of discharge to a facility and readmission after major surgery for gastrointestinal malignancy. Early identification of these high-risk patients can help focus resources for optimal disposition.
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