Optimal Modified Frailty Index Cutoff in Older Gastrointestinal Cancer Patients

2017 ◽  
Vol 83 (8) ◽  
pp. 860-865 ◽  
Author(s):  
Mary Garland ◽  
Fang-Chi Hsu ◽  
Perry Shen ◽  
Clancy J. Clark
Keyword(s):  
Cancer Patients ◽  
Cross Validation ◽  
Frailty Index ◽  
Postoperative Outcomes ◽  
Cancer Site ◽  
Optimal Cutoff ◽  
Major Morbidity ◽  
Gi Cancer ◽  
Modified Frailty Index ◽  
Fold Cross Validation

The newly characterized modified frailty index (mFI) is a robust predictor of postoperative outcomes for surgical patients. The present study investigates the optimal cutoff for mFI specifically in older gastrointestinal (GI) cancer patients undergoing surgery. All patients more than 60 years old who underwent surgery for a GI malignancy (esophagus, stomach, colon, rectum, pancreas, liver, and bile duct) were identified in the 2005 to 2012 National Surgical Quality Improvement Program, Participant Use Data File (NSQIP PUF). Patients undergoing emergency procedures, of American Society of Anesthesiologists (ASA) five status, or diagnosed with preoperative sepsis were excluded. Logistic regression modeling and 10-fold cross validation were used to identify an optimal mFI cutoff. A total of 41,455 patients (mean age 72, 47.4% female) met the eligibility criteria. Among them, 19.0 per cent (n = 7891) developed a major postoperative complication and 2.8 per cent (n = 1150) died within 30 days. A random sampling by a cancer site was performed to create 90 per cent training and 10 per cent test sample datasets. Using 10-fold cross validation, logistical regression models evaluated the association between mFI and endpoints of 30-day mortality and major morbidity at various cutoffs. Optimal cutoffs for 30-day mortality and major morbidity were mFI ≥ 0.1 and ≥0.2, respectively. After adjusting for age, sex, ASA, albumin ≥3g/dl, and body mass index ≥ 30 kg/m2, mFI ≥ 0.1 was associated with increased mortality (odds ratio (OR) 1.49, 1.30–1.71 95% confidence interval (CI), P < 0.001) and mFI ≥ 0.2 was associated with increased morbidity (OR 1.52, 1.39–1.65 95% CI, P < 0.001). For older GI cancer patients, a very low mFI was a predictor of poor postoperative outcomes with an optimal cutoff of two or more mFI characteristics.

scholarly journals Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients

2017 ◽  
Vol 115 (8) ◽  
pp. 997-1003 ◽  
Author(s):  
Sarah A. Vermillion ◽  
Fang-Chi Hsu ◽  
Robert D. Dorrell ◽  
Perry Shen ◽  
Clancy J. Clark
Keyword(s):  
Cancer Patients ◽  
Gastrointestinal Cancer ◽  
Frailty Index ◽  
Postoperative Outcomes ◽  
Modified Frailty Index

Modified frailty index predicts postoperative outcomes of spontaneous intracerebral hemorrhage

2018 ◽  
Vol 175 ◽  
pp. 137-143 ◽  
Author(s):  
Yukihiro Imaoka ◽  
Takayuki Kawano ◽  
Akihito Hashiguchi ◽  
Kenji Fujimoto ◽  
Keizou Yamamoto ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Frailty Index ◽  
Postoperative Outcomes ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Modified Frailty Index

scholarly journals Association of a Modified Frailty Index with Postoperative Outcomes after Ankle Fractures in Patients Aged 50 Years and Older

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002 ◽  
Author(s):  
Rishin Kadakia ◽  
Jason Bariteau ◽  
Catphuong Vu ◽  
Andrew Pao ◽  
Shay Tenenbaum
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Assessment Tool ◽  
Frailty Index ◽  
Reoperation Rate ◽  
Ankle Fractures ◽  
Postoperative Outcomes ◽  
Improvement Project ◽  
Modified Frailty Index ◽  
Reoperation Rates

Category: Ankle, Trauma Introduction/Purpose: Frailty, a multifaceted syndrome resulting from a decrease in physiologic reserves, has been previously shown to play a significant role in elderly morbidity and mortality. The literature on frailty within orthopaedic surgery is limited currently. No study to date has assessed frailty as a predictor of postoperative outcomes in elderly patients with ankle fractures. We hypothesized that increasing frailty would be associated with increased 30-day reoperation rates and increased postoperative complications. Methods: The National Surgical Quality Improvement Project (NSQIP) was queried using the appropriate CPT codes to identify inpatients from 2005-2014 who were aged 50 years and older that sustained an ankle fracture and underwent operative fixation. Frailty was assessed using a modified frailty index (MFI), abbreviated with 11 variables from the Canadian Study of Health and Aging Frailty Index. The primary outcome was 30-day reoperation rate and secondary outcomes were postoperative surgical and medical complications, readmission rates, and length of stay. Bivariate and multivariate analysis was used to determine association between outcomes and MFI. Results: 6,749 patients were identified, and the mean age of these patients was 64.4 years. Patients with increased MFI scores had significantly higher rates of postoperative complications. In addition, increased MFI scores was also associated with increased 30 day readmissions and reoperations. Multivariate analysis also demonstrated that MFI was a stronger predictor of 30 day reoperation rates (odds ratio of 17.7, P < 0.001) than age, wound class, and ASA class. Conclusion: Frailty has the potential to be an important predictive variable of postoperative outcomes in patients aged 50 years and older who sustain ankle fractures. The modified frailty index can be a valuable preoperative risk assessment tool for the orthopaedic surgeon. Further study is necessary to examine the effect of the MFI in a larger prospective setting.

Novel bypass risk predictive tool is superior to the 5-Factor Modified Frailty Index in predicting postoperative outcomes

2020 ◽  
Vol 72 (4) ◽  
pp. 1427-1435.e1
Author(s):  
Zein M. Saadeddin ◽  
Jeffrey D. Borrebach ◽  
Jacob C. Hodges ◽  
Efthymios D. Avgerinos ◽  
Michael Singh ◽  
...  
Keyword(s):  
Frailty Index ◽  
Postoperative Outcomes ◽  
Predictive Tool ◽  
Modified Frailty Index

Frailty: A major consideration for short- and long-term outcomes in resected pancreatic cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 418-418
Author(s):  
Ioannis Konstantinidis ◽  
Aaron G Lewis ◽  
Federrico Tozzi ◽  
Philip HG Ituarte ◽  
Susanne Warner ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Frailty Index ◽  
Postoperative Mortality ◽  
Postoperative Outcome ◽  
Postoperative Outcomes ◽  
Improvement Program ◽  
California Cancer Registry ◽  
Modified Frailty Index ◽  
Comorbidity Index ◽  
Short And Long Term

418 Background: Frailty has been associated with adverse postoperative outcomes. However, little is known about its correlation with survival in resected pancreatic cancer. This study examined the correlation of frailty with postoperative outcomes and survival after pancreatectomy for cancer. Methods: Data from National Surgical Quality Improvement Program (NSQIP) patients (n = 7400) who underwent pancreatectomy between 2011 to 2013. A modified frailty index (mFI) validated for use in NSQIP was used to examine correlations between frailty and postoperative outcomes. California Cancer Registry (CCR) data for patients (n = 4959) who underwent pancreatectomy for cancer between 2000 to 2012 was used to assess the association between the Charlson Comorbidity Index (CCI), as a surrogate for frailty, and overall survival. Results: The distribution of NSQIP patients according to the mFI was 0, 1, 2, 3, 4 in 2797 (37.8%), 3422 (46.2), 1074 (14.5), 104 (1.4) and 3 (0.04) respectively. The patients were divided to non frail (mFI = 0), mildly frail (mFI = 1-2), or severely frail (mFI3 ≥ 3). Overall, 8.7% of patients experienced a grade 4 Clavien complication and 3.1% experienced postoperative mortality. Worsening frailty correlated with an increase in grade 4 Clavien complications (non-frail: 6.3% vs. mildly frail: 9.7% vs. severely frail: 26.2%; p < 0.001) and mortality (1.9% vs. 3.8% vs. 4.7% respectively; p < 0.001). The majority of CCR patients had similarly few comorbidities: CCI: 0, 1, ≥ 2 in 3869 (77.8%), 861 (17.31%) and 243 (4.89%) respectively. Median survival decreased as CCI increased (for CCI 0, 1 and ≥ 2 was 23 vs. 19 vs. 15 months respectively; p < 0.001). Conclusions: Frailty is a powerful correlate of postoperative outcome and survival for resected pancreatic cancer patients and is an important consideration in planning for surgical intervention.

scholarly journals Predicting Postoperative Outcomes in Brain Tumor Patients With a 5-Factor Modified Frailty Index

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 147-154 ◽  
Author(s):  
Sakibul Huq ◽  
Adham M Khalafallah ◽  
Adrian E Jimenez ◽  
Abhishek Gami ◽  
Shravika Lam ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Respiratory Failure ◽  
Frailty Index ◽  
Postoperative Outcomes ◽  
Tumor Patients ◽  
Metabolic Derangement ◽  
Vein Thrombosis ◽  
Primary Surgery ◽  
Modified Frailty Index ◽  
Total Charges

Abstract BACKGROUND Frailty indices may represent useful decision support tools to optimize modifiable drivers of quality and cost in neurosurgical care. However, classic indices are cumbersome to calculate and frequently require unavailable data. Recently, a more lean 5-factor modified frailty index (mFI-5) was introduced, but it has not yet been rigorously applied to brain tumor patients. OBJECTIVE To investigate the predictive value of the mFI-5 on length of stay (LOS), complications, and charges in surgical brain tumor patients. METHODS We retrospectively reviewed data for brain tumor patients who underwent primary surgery from 2017 to 2018. Bivariate (ANOVA) and multivariate (logistic and linear regression) analyses assessed the predictive power of the mFI-5 on postoperative outcomes. RESULTS Our cohort included 1692 patients with a mean age of 55.5 yr and mFI-5 of 0.80. Mean intensive care unit (ICU) and total LOS were 1.69 and 5.24 d, respectively. Mean pulmonary embolism (PE)/deep vein thrombosis (DVT), physiological/metabolic derangement, respiratory failure, and sepsis rates were 7.2%, 1.1%, 1.6%, and 1.7%, respectively. Mean total charges were $42 331. On multivariate analysis, each additional point on the mFI-5 was associated with a 0.32- and 1.38-d increase in ICU and total LOS, respectively; increased odds of PE/DVT (odds ratio (OR): 1.50), physiological/metabolic derangement (OR: 3.66), respiratory failure (OR: 1.55), and sepsis (OR: 2.12); and an increase in total charges of $5846. CONCLUSION The mFI-5 is a pragmatic and actionable tool which predicts LOS, complications, and charges in brain tumor patients. It may guide future efforts to risk-stratify patients with subsequent impact on postoperative outcomes.

Assessment of survival after primary treatment in ovarian cancer patients using a modified frailty index

2019 ◽  
Vol 154 ◽  
pp. 209
Author(s):  
G.Z. Dal Molin ◽  
A.K. Sood ◽  
B. Fellman ◽  
R.L. Coleman ◽  
S.N. Westin ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Frailty Index ◽  
Primary Treatment ◽  
Modified Frailty Index

scholarly journals Commentary: Predicting Postoperative Outcomes in Brain Tumor Patients With a 5-Factor Modified Frailty Index

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. E36-E38
Author(s):  
Michael Zhang ◽  
Melanie Hayden Gephart ◽  
Corinna C Zygourakis
Keyword(s):  
Brain Tumor ◽  
Frailty Index ◽  
Postoperative Outcomes ◽  
Tumor Patients ◽  
Modified Frailty Index

Association of nutritional parameters and survival in parenteral nutrition-supported (PN) gastrointestinal cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10078-10078
Author(s):  
Wenli Liu ◽  
Aiham Qdaisat ◽  
Eric Lee ◽  
Jason Yeung ◽  
Khanh Vu ◽  
...  
Keyword(s):  
Amino Acids ◽  
Cancer Patients ◽  
Plasma Glucose ◽  
Weight Change ◽  
Ideal Body Weight ◽  
Analysis Data ◽  
Cancer Site ◽  
Maximum Plasma ◽  
Nutritional Parameters ◽  
Gi Cancer

10078 Background: PN is a major tool in managing nutritional challenges in cancer patients. However, a clear set of clinical and biochemical indices to determine PN application in cancer patients has not been developed. We assessed the association between PN related nutritional parameters and survival in a large group of gastrointestinal (GI) cancer patients. Methods: 1197 consecutive GI cancer patients who received PN support between 08/01/08 – 08/01/13 were reviewed. Height, weight, plasma glucose (baseline and within 48 hours after PN initiation), surgical history, and pharmacy data including PN contents (dextrose, amino acids, and fat) and non-PN dextrose or fat in drug administration were recorded. Body mass index (BMI), Ideal body weight (IBW), PN and non-PN Calorie, and nitrogen were calculated for analysis. Data were entered into a multivariate analysis controlling for age, gender, cancer site, and medical comorbidities. Results: Median BMI was 25.4. 70% of the patients had unsteady weight ( > 2.5% change) before PN initiation. The magnitude of weight change was inversely related to survival (HR 1.02), P < 0.001). Patients with BMI > 25 and < 7.5% weight change prior to PN initiation had the most favorable survival. Glycemic instability (maximum plasma glucose variation > 100mg/dL) was independently related to shorter survival (HR 1.53, P < 0.001). Total calorie by IBW (kcal/kg/day) (HR 0.97, P < 0.001), non-PN calorie % (HR 1.04, P < 0.001), and calorie to nitrogen ratio (kcal:g) (HR 1.02, P < 0.001) were all independently associated with overall survival. Conclusions: Lower BMI, weight instability, and glycemic instability were adversely associated with survival. Higher total PN calorie and amino acid support were associated with better survival. Higher non-PN calorie % was adversely related to survival. Future studies must focus on developing a set of indices incorporating independent prognostic clinical and biochemical factors in determining PN application and monitoring in cancer patients. Optimum calorie and amino acids in PN support for cancer patients also require further investigation.

Memorial Sloan Kettering-Frailty Index (MSK-FI): Validation and its relationship with postoperative outcomes of older survivors of cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 172-172
Author(s):  
Armin Shahrokni ◽  
Amy Tin ◽  
Koshy Alexander ◽  
Saman Sarraf ◽  
Anoushka Afonso ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Cancer Patients ◽  
Daily Living ◽  
Frailty Index ◽  
Postoperative Outcomes ◽  
Care Process ◽  
Icu Admission ◽  
Frail Patients ◽  
Instrumental Activities

172 Background: Older cancer patients are at higher risk for poor postoperative outcomes. We tested the validity and utility of Memorial Sloan Kettering-Frailty Index (MSK-FI) in this setting. Methods: In a single institution, prospective cohort study, patients age 75+ received comprehensive geriatric assessment (CGA) by the Geriatrics service during preoperative evaluation. The MSK-FI was developed based on the modified Frailty Index, incorporating 10 comorbid conditions and one item related to basic and instrumental activities of daily living. With the total score ranging from 0 to 11, a score of ≥ 3 was considered frail. We validated the MSK-FI against the CGA, and assessed the relationship between MSK-FI frailty with short term (hospital length of stay (LOS), intensive care unit (ICU) admission) and long-term (overall survival) postoperative outcomes utilizing multivariable linear, logistic, and cox regression models, adjusting for age, duration of surgery, American Society of Anesthesiologists physical status classification, and preoperative albumin level. Results: In total, 1,137 cancer patients (median age 80) were included in the study. The prevalence of frailty based on MSK-FI was 41%. Frail patients were more likely to have poor Karnofsky Performance Status (56% vs. 29%), be dependent in basic and instrumental activities of daily living (72% vs. 40% and 64% vs. 34%), experienced a fall in the past year (30% vs. 18%), have slower gait speed (49% vs. 22%),be depressed (66% vs. 49%), have limited social activity (62% vs. 43%), take ≥ 5 medications (63% vs. 25%), experienced significant weight loss (24% vs. 16%), and suffer from polycomorbid conditions (87% vs. 26%). Frailty was associated with longer LOS in the hospital (1.9 days, p <0.0001) and higher odds of ICU admission (OR = 2.34, p = 0.005). With the median follow up of 12.1 months for survivors, frail patients were at higher risk for overall mortality (HR = 1.67, p < 0.001). Conclusions: MSK-FI is a valid instrument in predicting short and long-term postoperative outcomes of older adults with cancer. Future studies should assess the impact of administering MSK-FI on surgical decision-making, postoperative health care process, and outcomes.

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