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THE IMPACT OF FRAILTY ON SURGICAL AND NON-SURGICAL SITE COMPLICATIONS IN GASTRIC CANCER PATIENTS UNDERGOING GASTRECTOMY
Katsunobu Sakurai
*1, Naoshi Kubo
1, Tatsuro Tamura
2, Tsuyoshi Hasegawa
1, Toru Inoue
1, Yukio Nishiguchi
1, Masakazu Yashiro
2, Kiyoshi Maeda
21Gastroenterological surgery, Osaka Shiritsu Sogo Iryo Center, Osaka, Osaka, Japan; 2Osaka Koritsu Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osaka, Osaka, Japan
Background. The aim of this study was to determine the differential impact of frailty on surgical site complications (SSCs) and nonsurgical site complications (non-SSCs) in gastric cancer (GC) patients undergoing gastrectomy.
Methods. This study assessed preoperative frailty using a cumulative deficit frailty index (FI) method in 395 patients scheduled for gastrectomy between January 2016 and December 2023. This frailty checklist included physical, social, and psychological frailty. Patients were divided into two groups (high FI vs. low FI) to examine the impact of frailty on SSC and non-SSC. Complications were defined as grade 2 or higher according to the Clavien-Dindo classification. SSC was defined as leakage, pancreatic fistula, abscess, anastomotic stenosis and bleeding, bowel obstruction, and paralytic ileus. Non-SSC was defined as any complication other than SSC. An optimal cut-point for FI in each complication was determined by receiver operating characteristic analysis.
Results. The overall complication and non-SSC rates were significantly higher in the high FI group than in the low FI group, whereas the high and low FI groups exhibited similar rates of SSC. In multivariate analyses for all complications, high FI, BMI (?22), stenosis, approach (open) and operative time (?370) were identified as independent risk factors [high FI; HR 2.72 (1.51-4.95),
p<0.001]. In multivariate analyses for SSCs, FI were not identified as an independent risk. In multivariate analyses for non-SSCs, sex (male), BMI (?22) and high FI were identified as independent risk factors for non-SSCs [high FI?HR 8.13 (3.67-18.85),
p<0.001]. The high FI group had significantly more older patients, lower albumin, more stenosis, more blood loss, longer hospital stays, more non-home discharges, more all complications, and more non-SSCs than the low FI group. Among non-SSCs, high FI patients had significantly more pneumonia, more urinary tract infections, and more arrhythmias than low FI patients. In a prediction model for non-SSC combining sex (male), high BMI and high FI, the incidence of non-SSC was 0% in patients with no applicable risk factors, 3.6% in patients with one applicable risk factor, 13.0% in patients with two applicable risk factors, and 37.1% in patients with all three risk factors. (p<0.001).
Conclusions. High FI was an independent risk factor for all complications and non-SSC in patients undergoing gastrectomy for GC. The non-SSC risk model, which incorporates FI, BMI, and sex, is an effective tool for identifying individuals at elevated risk for non-SSC in GC patients.
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