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FRAILTY AS A PREDICTOR FOR POSTOPERATIVE OUTCOMES FOLLOWING PANCREATICODUODENECTOMY.
Vivian Li, Amen Awan, Pablo E. Serrano*
McMaster University Faculty of Health Sciences, Hamilton, ON, Canada

Background: Frailty, defined as a state of decreased physiologic reserve, characterized by a loss of resiliency in the face of acute stress is a condition that is frequently encountered by pancreas surgeons. We sought to evaluate frailty as a predictor of postoperative complications following pancreaticoduodenectomy using the modified frailty index (mFI).
Methods: This is a retrospective cohort study of consecutive adult patients undergoing pancreaticoduodenectomy between April 1, 2011 and April 30, 2020 at a single academic institution. An mFI consisting of 11 variables adapted for the National Surgical Quality Improvement Program database from the Canadian Study of Health and Aging Frailty Index was used. These variables have been previously validated and include patient comorbidities and functional abilities. Patients were stratified into two groups, high mFI ('0.27) and low mFI (<0.27). Postoperative complications were graded using Clavien-Dindo. The effect of mFI on postoperative complications and 90-day mortality was evaluated using multiple logistic regression and expressed as odds ratio (OR) and 95% confidence interval (CI).
Results: Among 554 pancreaticoduodenectomies, there were 64/554 (12%) patients with a high mFI. Low mFI patients were significantly younger (67 vs. 72 years, p<0.001). Both groups had similar baseline and operative characteristics, including: proportion of pancreatic adenocarcinoma (45% vs. 45%, p=0.975), intermediate or hard pancreatic texture (39% vs. 32%, p=0.512), operative room time (370 vs. 368 min, p=0.630), and drain placement (72% vs. 75%, p=0.642), respectively. The high mFI group had significantly longer median length of hospital stay (11 vs. 8 days, p=0.016), a higher rate of intensive care unit (ICU) admission (73% vs. 43%, p<0.001), and a higher 90-day mortality rate (11% vs. 4.1%, p=0.017). By multivariate analysis, mFI score was an independent predictor for the development of any type of postoperative complications (OR 1.44, 95%CI 1.02 to 2.10). MFI score was also an independent predictor for the development of major complications (OR 1.44, 95%CI 1.05 to 1.98).
Discussion: The mFI predicts postoperative outcomes following pancreaticoduodenectomy and can be used as a risk stratification tool for patients being considered for surgery.


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