Modified Frailty Index Predicts Postoperative Outcomes in Patients Undergoing Radical Pelvic Surgery

Patients undergoing radical pelvic surgery such as proctectomy or radical cystectomy are at risk of experiencing a variety of complications. Frailty renders patients vulnerable to adverse events. We hypothesize that frailty measured preoperatively using a validated scoring system correlates with increased likelihood of experiencing Clavien-Dindo grade IV complications and 30-day mortality and may be used as a predictive model for patients preoperatively. The NSQIP database was queried for patients who underwent proctectomy or radical cystectomy from 2008 to 2012. Pre-operative frailty was calculated using the 11-point modified frailty index (MFI). Patients were scored based on the presence of indicators and categorized into two groups (<3 or ≥3). Major postoperative morbidities and mortality were identified and analyzed in each group. 10,048 proctectomy and cystectomy patients were identified. The MFI was found to be predictive of both 30-day mortality ( P < 0.0001) and Clavien-Dindo grade IV complications ( P < 0.0001). Receiver operating characteristic analysis demonstrated improved discriminative power of the MFI with the addition of American Society of Anesthesiologists class for both prediction of complications and 30-day mortality. An MFI score of ≥3 is predictive of postoperative morbidity and mortality. Providers should be encouraged to calculate frailty preoperatively to predict adverse outcomes.

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Discriminative Ability of Commonly Used Indexes to Predict Adverse Outcomes After Radical Cystectomy: Comparison of Demographic Data, American Society of Anesthesiologists, Modified Charlson Comorbidity Index, and Modified Frailty Index

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2018.02.009 ◽

2018 ◽

Vol 16 (4) ◽

pp. e843-e850 ◽

Cited By ~ 21

Author(s):

Xiaosong Meng ◽

Benjamin Press ◽

Audrey Renson ◽

James S. Wysock ◽

Samir S. Taneja ◽

...

Keyword(s):

Radical Cystectomy ◽

Charlson Comorbidity Index ◽

Demographic Data ◽

Frailty Index ◽

Adverse Outcomes ◽

Discriminative Ability ◽

Modified Frailty Index ◽

Comorbidity Index ◽

American Society ◽

American Society Of Anesthesiologists

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Frailty as a Predictor of Postoperative Outcomes among Patients with Head and Neck Cancer

Otolaryngology ◽

10.1177/0194599818825466 ◽

2019 ◽

Vol 160 (4) ◽

pp. 664-671 ◽

Cited By ~ 6

Author(s):

Kristen D. Pitts ◽

Alberto A. Arteaga ◽

Benjamin P. Stevens ◽

William C. White ◽

Dan Su ◽

...

Keyword(s):

Head And Neck Cancer ◽

Length Of Stay ◽

Head And Neck ◽

Neck Cancer ◽

Perioperative Complications ◽

Frailty Index ◽

Perioperative Outcomes ◽

Modified Frailty Index ◽

American Society ◽

American Society Of Anesthesiologists

Objectives To understand measures of frailty among preoperative patients and explain how these can predict perioperative outcomes among patients with head and neck cancer. Study Design Retrospective cross-sectional case series with chart review. Setting Academic tertiary medical center. Subjects and Methods A retrospective review was performed of patients presenting to an academic hospital following a surgical procedure for a head and neck cancer diagnosis. Charts were queried for preoperative medical diagnoses to calculate 2 frailty scores: the American College of Surgeons National Surgical Quality Improvement Program modified frailty index and the Johns Hopkins Adjusted Clinical Groups frailty index. The American Society of Anesthesiologists classification system was also analyzed as a predictor. Primary outcomes were mortality, 30-day readmission, and length of stay. Perioperative complications and discharge disposition were also evaluated. Results A total of 410 charts were queried between January 2014 and December 2017. Mortality was 11%; mean ± SD length of stay was 7.4 ± 5.5 days; and the readmission rate was 17%. The modified frailty index score significantly increased the odds of mortality (odds ratio = 1.475, P = .012) and readmission (odds ratio = 1.472, P = .004), the length of stay (relative risk = 1.136, P = .001), and the number of perioperative complications. The American Society of Anesthesiologists classification was also significantly associated with poor outcomes, including readmission, length of stay, and perioperative complications. The Adjusted Clinical Groups index was not a significant predictor of outcomes in this study population. Conclusions This study demonstrated a significant increase in poor perioperative outcomes and mortality among patients with head and neck cancer and increased frailty, as measured by the modified frailty index.

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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

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Comparison of Sarcopenia with Modified Frailty Index as a Predictor of Adverse Outcomes in Critically Ill Elderly Patients

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i32b31763 ◽

2021 ◽

pp. 200-206

Author(s):

Shrirang Bhurchandi ◽

Sachin Agrawal ◽

Sunil Kumar ◽

Sourya Acharya

Keyword(s):

Elderly Patients ◽

Critically Ill ◽

Health Care Cost ◽

Frailty Index ◽

The Elderly ◽

Time Frame ◽

Adverse Outcomes ◽

Cross Sectional ◽

Parametric Data ◽

Modified Frailty Index

Background: Ageing is a global fact affecting both developed and developing countries.It brings out various catabolic changes in body resulting in frailty(i.e. the person is not able to with stand minor stresses of the environment, due to reduced reserves in psychologicalreserve of several organ system).Thus causing a great burden of disease, dependence & health care cost. Sarcopenia is the leading component for frailty in the elderly population, but very few studies have been done in India for correlating frailty with sarcopenia. Aim: To compare sarcopenia with modified frailty index (MFI) as a predictor of adverse outcomes in critically ill elderly patients. Methodology: Cross-sectional study will be performed on all the critically ill geriatric subjects/patients coming to all the ICU's of AVBRH, Sawangi (M), Wardha who will satisfy various inclusion and exclusion criteria for selection and all standard parametric & non-parametric data will be assessed by using standard descriptive & inferential statistics. Expected Results: In our study, we are anticipating that the Modified frailty index to be a better predictor of adverse outcomes in terms of mortality as compared to sarcopenia in the critically ill elderly patients. Also, we are anticipating that sarcopenia to be the most important contributor of frailty in critically ill elderly patients and the prevalence of frailty will be high in critically ill elderly patients. Limitation: Due to limited time frame & resources we will not be able to follow up the patients.

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Assessing Risk of Severe Complications after Endoscopic Transnasal Transsphenoidal Surgery: A Comparison of Frailty, American Society of Anesthesiologists, and Comorbidity Scores

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1740577 ◽

2021 ◽

Author(s):

Jordan M. Sukys ◽

Roy Jiang ◽

Richard P. Manes

Keyword(s):

Frailty Index ◽

Information Criteria ◽

Improvement Program ◽

Pituitary Mass ◽

Complication Risk ◽

Comorbidity Scores ◽

Multivariable Regression ◽

American Society ◽

Akaike’S Information Criteria ◽

American Society Of Anesthesiologists

Abstract Objective This study aimed to improve age-independent risk stratification for patients undergoing endoscopic transnasal transsphenoidal (TNTS) approach to pituitary mass resection by investigating the associations between frailty, American Society of Anesthesiologists (ASA), and comorbidity scores with severe complications following TNTS. Design This study is a retrospective review. Setting This review was conducted utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Participants A total of 680 cases of TNTS identified from 2010 to 2013 were included in this study. Main Outcome Measures The modified frailty index (mFI) was calculated to quantify frailty. ASA and Charlson's comorbidity index (CCI) scores were obtained as physiologic status and comorbidity-based prognostic markers. Severe complications were separated into intensive care unit (ICU)-level complications, defined by Clavien–Dindo grade IV (CDIV) criteria, and mortality. Results Overall, 24 CDIV complications (3.5%) and 6 deaths (0.9%) were recorded. Scores for mFI (p = 0.01, R 2 = 0.97) and ASA (p = 0.04., R 2 = 0.87) were significantly correlated with CDIV complications. ASA scores were significantly correlated with mortality (p = 0.03, R 2 = 0.87), as well as independently associated with CDIV complication by multivariable regression models (odds ratio [OR] = 2.96, 95% confidence interval [CI]: 1.35–6.83, p < 0.01), while mFI was not. CCI was not significantly associated with CDIV complications or mortality. A multivariable regression model incorporating ASA had a lower Akaike's Information Criteria (AIC; 188.55) than a model incorporating mFI (195.99). Conclusion Frailty and physiologic status, as measured by mFI and ASA scores respectively, both correlate with ICU-level complications after TNTS. ASA scores demonstrate greater clinical utility than mFI scores; however, as they are more easily generated, uniquely correlated with mortality and independently associated with ICU-level complication risk on multivariable regression analysis.

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Short- and Long-Term Evaluation of Renal Function after Radical Cystectomy and Cutaneous Ureterostomy in High-Risk Patients

Journal of Clinical Medicine ◽

10.3390/jcm9072191 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2191

Author(s):

Massimiliano Creta ◽

Ferdinando Fusco ◽

Roberto La Rocca ◽

Marco Capece ◽

Giuseppe Celentano ◽

...

Keyword(s):

Renal Function ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Kidney Injury ◽

Risk Patients ◽

Term Evaluation ◽

Gfr Decline ◽

American Society ◽

American Society Of Anesthesiologists ◽

Cutaneous Ureterostomy

Deterioration of renal function has been reported after radical cystectomy (RC) with urinary diversion. We investigated renal function changes in elderly bladder cancer (BCa) patients who underwent RC with cutaneous ureterostomy (CU) urinary diversion. We performed a retrospective, observational study. BCa patients aged ≥75 with an American Society of Anesthesiologists (ASA) class greater than II were included. Glomerular filtration rate (GFR) was the main outcome measure. GFR values were recorded preoperatively, at discharge, at 6-month follow-up, and yearly up to 60 months. A total of 70 patients with a median age of 78.0 years were identified. Median preoperative GFR was 74.3 mL/min/1.73 m2 and declined significantly to 54.6 mL/min/1.73 m2 after 6 months (p < 0.001). A gradual GFR decline was observed thereafter, reaching a median value of 46.2 after 60 months. Preoperative GFR and acute kidney injury were significant predictors of fast deterioration of GFR and of 25% deterioration of GFR after 12 months. Elderly BCa patients with high comorbidity rates undergoing RC with CU should be carefully informed about the risk of GFR deterioration and the need for adequate monitoring.

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