Faculty Collaboration Database

Modified Frailty Index Predicts Morbidity and Mortality After Pancreaticoduodenectomy. Ann Surg Oncol 2017 Jun;24(6):1714-1721

Date

01/07/2017

Pubmed ID

28058551

Pubmed Central ID

PMC7064816

DOI

10.1245/s10434-016-5715-0

Scopus ID

2-s2.0-85008476094 (requires institutional sign-in at Scopus site)   106 Citations

Abstract

BACKGROUND: Pancreatic cancer is a disease of older adults, who may present with limited physiologic reserve. The authors hypothesized that a frailty index can predict postoperative outcomes after pancreaticoduodenectomy (PD).

METHODS: All patients who underwent PD were identified in the 2005-2012 NSQIP Participant Use File. Patients undergoing emergency procedures, those with an American Society of Anesthesiologists (ASA) classification of five, and those with a diagnosis of preoperative sepsis were excluded from the study. A modified frailty index (mFI) was defined by 11 variables within the National Surgical Quality Improvement Program (NSQIP) previously used for the Canadian Study of Health and Aging-Frailty Index. An mFI score of 0.27 or higher was defined as a high mFI. Uni- and multivariate analyses were performed to evaluate postoperative outcomes.

RESULTS: This study enrolled 9986 patients (age 65 ± 12 years, 48.8% female) who underwent PD. Of these patients, 6.4% (n = 637) had a high mFI (>0.27). Increasing mFI was associated with higher prevalence of postoperative morbidity (p < 0.001) and 30-days mortality (p < 0.001). In the univariate analysis, high mFI was associated with increased morbidity (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.43-1.97; p < 0.001) and 30-days mortality (OR 2.45; 95% CI 1.74-3.45; p < 0.001). After adjustment for age, sex, ASA classification, albumin level, and body mass index (BMI), high mFI remained an independent preoperative predictor of postoperative morbidity (OR 1.544; 95% CI 1.289-1.850; p < 0.0001) and 30-days mortality (OR 1.536; 95% CI 1.049-2.248; p = 0.027).

CONCLUSIONS: High mFI is associated with postoperative morbidity and mortality after PD and can aid in preoperative risk stratification.

Author List

Mogal H, Vermilion SA, Dodson R, Hsu FC, Howerton R, Shen P, Clark CJ

MESH terms used to index this publication - Major topics in bold

Aged
Female
Follow-Up Studies
Frailty
Humans
Male
Middle Aged
Morbidity
Pancreatic Neoplasms
Pancreaticoduodenectomy
Postoperative Complications
Prognosis
Quality Improvement
Risk Assessment
Survival Rate