Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study

Objectives To evaluate the impact of preoperative frailty on short-term outcomes following complex head and neck surgeries (HNSs). Study Design Cross-sectional database analysis. Setting American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Methods The 2005 to 2017 ACS-NSQIP was queried for patients undergoing complex HNS. Five-item modified frailty index (mFI) was calculated based on functional status and history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and chronic hypertension. Results A total of 2786 patients (73.1% male) with a mean age of 62.0 ± 11.6 years were included. Compared to nonfrail patients (41.2%), patients with mFI ≥1 (58.8%) had shorter length of operation ( P = .021), longer length of stay (LOS) ( P < .001), and higher rates of 30-day reoperation ( P = .009), medical complications ( P < .001), discharge to nonhome facility (DNHF) ( P < .001), and mortality ( P = .047). These parameters remained statistically significant when compared across all individual mFI scores (all P < .05). After adjusting for age, sex, race, body mass index, smoking, and American Society of Anesthesiologists score via multivariate logistic regression, patients with mFI ≥1 were significantly more likely to undergo reoperation (odds ratio [OR], 1.39), surgical complications (OR, 1.19), medical complications (OR, 1.55), prolonged LOS (OR, 1.29), and DNHF (OR, 1.56) (all P < .05). Multivariate logistic regression also demonstrated that after adjusting for confounders, compared to patients with mFI = 1, patients with mFI = 2-5 (18.7%) were more likely to undergo shorter operations (OR, 0.74), have medical (OR, 1.46) or any complications (OR, 1.27), and have DNHF (OR, 1.62) (all P < .05). Conclusion The 5-point mFI can independently predict short-term surgical outcomes following complex HNS. This simple and reliable metric can potentially lead to improved preoperative counseling and postoperative planning for complex HNS patients.

Download Full-text

Frailty predicts outcome of partial nephrectomy and guides treatment decision towards active surveillance and tumor ablation

World Journal of Urology ◽

10.1007/s00345-020-03556-7 ◽

2021 ◽

Author(s):

M. T. Walach ◽

M. F. Wunderle ◽

N. Haertel ◽

J. K. Mühlbauer ◽

K. F. Kowalewski ◽

...

Keyword(s):

Active Surveillance ◽

Surgical Outcome ◽

Frailty Index ◽

Treatment Decision ◽

Solitary Kidney ◽

Tumor Ablation ◽

Renal Masses ◽

Skeletal Muscle Index ◽

Decision Tools ◽

Modified Frailty Index

Abstract Purpose To examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA). Methods Frailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with localized renal masses. Renal tumor anatomy was classified according to the RENAL nephrometry system. Regression analyses were performed to assess predictors of surgical outcome of patients undergoing NSS as well as to identify possible influencing factors of patients undergoing alternative therapies (AS/TA). Results Overall 409 patient underwent NSS while 38 received AS or TA. Patients undergoing TA/AS were more likely to be frail or comorbid compared to patients undergoing NSS (aaCCI: p < 0.001, 11-CSHA: p < 0.001). Gender and tumor complexity did not vary between patients of different treatment approach. 11-CSHA and aaCCI were identified as independent predictors of major postoperative complications (11-CSHA ≥ 0.27: OR = 3.6, p = 0.001) and hospital re-admission (aaCCI ≥ 6: OR = 4.93, p = 0.003) in the NSS cohort. No impact was found for albumin levels and SMI. An aaCCI > 6 and/or 11-CSHA ≥ 0.27 (OR = 9.19, p < 0.001), a solitary kidney (OR = 5.43, p = 0.005) and hypoalbuminemia (OR = 4.6, p = 0.009), but not tumor complexity, were decisive factors to undergo AS or TA rather than NSS. Conclusion In patients with localized renal masses, frailty and comorbidity indices can be useful to predict surgical outcome and support decision-making towards AS or TA.

Download Full-text

210. Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool

The Spine Journal ◽

10.1016/j.spinee.2020.05.621 ◽

2020 ◽

Vol 20 (9) ◽

pp. S103-S104

Author(s):

Peter G. Passias ◽

Katherine E. Pierce ◽

Virginie Lafage ◽

Renaud Lafage ◽

Breton Line ◽

...

Keyword(s):

Risk Assessment ◽

Assessment Tool ◽

Frailty Index ◽

Surgical Correction ◽

Risk Assessment Tool ◽

Baseline Risk ◽

Spinal Deformities ◽

Functional Changes ◽

Modified Frailty Index

Download Full-text

MP63-01 MODIFIED FRAILTY INDEX PREDICTS MORTALITY AND ADVERSE OUTCOMES IN PATIENTS UNDERGOING RENAL SURGERY: ANALYSIS OF THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE

The Journal of Urology ◽

10.1016/j.juro.2015.02.2333 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Jamie S. Pak ◽

Danny Lascano ◽

Julia B. Finkelstein ◽

Mark V. Silva ◽

G. Joel DeCastro ◽

...

Keyword(s):

Quality Improvement ◽

Frailty Index ◽

Adverse Outcomes ◽

Quality Improvement Program ◽

Renal Surgery ◽

Improvement Program ◽

Surgical Quality ◽

Modified Frailty Index

Download Full-text

The modified frailty index-11 predicts medium-term outcomes after endovascular revascularisation for chronic limb threatening ischaemia in Asian patients

Vascular ◽

10.1177/1708538120988228 ◽

2021 ◽

pp. 170853812098822

Author(s):

Shereen XY Soon ◽

Reuban D’Çruz ◽

Charyl JQ Yap ◽

Wei Ling Tay ◽

Siew Ping Chng ◽

...

Keyword(s):

Complication Rate ◽

Early Recognition ◽

Frailty Index ◽

Arterial Disease ◽

Unplanned Readmission ◽

Medium Term ◽

Post Intervention ◽

Asian Patients ◽

Modified Frailty Index ◽

The Mean

Objective The aim was to evaluate the utility of frailty, as defined by the modified Frailty Index-1 1 (mFI-11) on predicting outcomes following endovascular revascularisation in Asian patients with chronic limb-threatening ischaemia (CLTI). Methods CLTI patients who underwent endovascular revascularisation between January 2015 and March 2017 were included. Patients were retrospectively scored using the mFI-11 to categorise frailty as low, medium or high risk. Observed outcomes included 30-day complication rate and unplanned readmissions, 1-, 6- and 12-month mortality, and ambulation status at 6- and 12 months post-intervention. Results A total of 233 patients (250 procedures) were included; 137 (58.8%) were males and the mean age was 69.0 (±10.7) years. 202/233 (86.7%) were diabetic and 196/233 (84.1%) had a prior diagnosis of peripheral arterial disease (PAD). The mean mFI-11 score was 4.2 (±1.5). 28/233 (12.0%), 155/233 (66.5%), and 50/233 (21.5%) patients were deemed low (mF-11 score 0–2), moderate (mFI-11 score 3–5) and high (mFI-11 score 5–7) frailty risk, respectively. High frailty was associated with an increased 12-month mortality (OR 8.54, 95% CI 1.05–69.5; p = 0.05), 30-day complication rate (OR 9.41, 95% CI 2.01–44.1; p < 0.01) and 30-day unplanned readmission (OR 5.06, 95% CI 1.06–24.2; p = 0.04). Furthermore, a high score was associated with a significantly worse 6- (OR 0.320, 95% CI 0.120–0.840; p = 0.02) and 12-month (OR 0.270, 95% CI 0.100–0.710; p < 0.01) ambulatory status. Conclusion The mFI-11 is a useful, non-invasive tool that can be readily calculated using readily available patient data, for prediction of medium-term outcomes for Asian CLTI patients following endovascular revascularisation. Early recognition of short- and mid-term loss of ambulation status amongst high-frailty patients in this challenging cohort of patients could aid decision-making for whether a revascularisation or amputation-first policy is appropriate, and manage patient and caregiver expectations on potential improvement in functional outcome.

Download Full-text