THE IMPACT OF FRAILTY ON PATIENTS UNDERGOING LIVER RESECTION FOR HEPOCELLULAR CARCINOMA: A REVIEW OF THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM
Jacqueline Dauch*, Mohammad Khreiss, Catherine OGrady, Chiu-Hsieh Hsu, Amanda Arrington, Taylor S. Riall
University of Arizona College of Medicine - Tucson, Tucson, AZ
Background: Frailty is highly prevalent in patients with malignancy and is associated with high risk of morbidity and mortality after operative interventions. The impact of frailty on patients undergoing liver resection for Hepatocellular Carcinoma (HCC) has not been studied. The aim of this study was to assess the impact of frailty on short term outcomes after liver resection in patients with HCC.
Methods: We used the National Surgical Quality Improvement Program (NSQIP) participant use files to evaluate all patients undergoing hepatectomy for HCC between 2014-2017. The 5-item Modified Frailty Index (mFI) was calculated using NSQIP variables. We included all patients with complete mFI information in the analysis. Patients were divided into three categories based on the mFI (0= non-frail, 1-2=prefrail, ≥ 3 =frail). Outcome measures included minor and major morbidity as defined by the Clavien-Dindo classification (I/II vs III/IV/V), 30-day mortality, need for readmission, unfavorable discharge (not to home), bile leak and liver failure.
Results: A total of 2533 patients were included in the analysis. Based on their mFI, 843 (33.28 %) were non-frail, 1638 (64.67 %) were pre-frail, and 52 (0.02%) were frail. On multivariate analysis, patients who were frail were more likely to be discharged to a facility than patients who were not frail (OR 2.32, 95% CI 1.05-5.13, p=0.04). They were also more likely to experience major morbidity (OR 2.08, 95% CI 1.01-4.29, p=0.048). There was no significant difference between patients who were frail and those who were not frail in minor morbidity (OR 1.77, 95% CI 0.96-3.28, p=0.07), hospital readmission (OR 1.42, 95% CI 0.56-3.55, p=0.46), bile leak (OR 0.83, 95% CI 0.26-2.86, p=0.83) and liver failure (OR 1.11. 95% CI 0.40-3.06, p=0.84).
Conclusion:
Frailty is associated with increased risk of morbidity, and unfavorable discharge in patients undergoing liver resection for hepatocellular carcinoma. We recommend the use of the 5-item Modified Frailty Index to guide risk stratification, optimization and counseling.
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