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.

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

Adapting the 5-factor modified frailty index for prediction of postprocedural outcome in patients with unruptured aneurysms

2021 ◽  
pp. 1-8
Author(s):  
James Feghali ◽  
Abhishek Gami ◽  
Sarah Rapaport ◽  
Jaimin Patel ◽  
Adham M. Khalafallah ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Frailty Index ◽  
Multivariable Analysis ◽  
Unruptured Aneurysm ◽  
Improvement Program ◽  
Unruptured Aneurysms ◽  
Major Complications ◽  
C Statistic ◽  
Physical Status Classification ◽  
Modified Frailty Index

OBJECTIVE The 5-factor modified frailty index (mFI-5) is a practical tool that can be used to estimate frailty by measuring five accessible factors: functional status, history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. The authors aimed to validate the utility of mFI-5 for predicting endovascular and microsurgical treatment outcomes in patients with unruptured aneurysms. METHODS A prospectively maintained database of consecutive patients with unruptured aneurysm who were treated with clip placement or endovascular therapy was used. Because patient age is an important predictor of treatment outcomes in patients with unruptured aneurysm, mFI-5 was supplemented with age to create the age-supplemented mFI-5 (AmFI-5). Associations of scores on these indices with major complications (symptomatic ischemic or hemorrhagic stroke, pulmonary embolism, pneumonia, or surgical site infection requiring reoperation) were evaluated. Validation was carried out with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2006–2017). RESULTS The institutional database included 275 patients (88 underwent clip placement, and 187 underwent endovascular treatment). Multivariable analysis of the surgical cohort showed that major complication was significantly associated with mFI-5 (OR 2.0, p = 0.046) and AmFI-5 (OR 1.9, p = 0.028) scores. Significant predictive accuracy for major complications was provided by mFI-5 (c-statistic = 0.709, p = 0.011) and AmFI-5 (c-statistic = 0.720, p = 0.008). The American Society of Anesthesiologists Physical Status Classification System (ASA) provided poor discrimination (area under the curve = 0.541, p = 0.618) that was significantly less than that of mFI-5 (p = 0.023) and AmFI-5 (p = 0.014). Optimal relative fit was achieved with AmFI-5, which had the lowest Akaike information criterion value. Similar results were obtained after equivalent analysis of the endovascular cohort, with additional significant associations between index scores and length of stay (β = 0.6 and p = 0.009 for mFI-5; β = 0.5 and p = 0.003 for AmFI-5). In 1047 patients who underwent clip placement and were included in the NSQIP database, mFI-5 (p = 0.001) and AmFI-5 (p < 0.001) scores were significantly associated with severe postoperative adverse events and provided greater discrimination (c-statistic = 0.600 and p < 0.001 for mFI-5; c-statistic = 0.610 and p < 0.001 for AmFI-5) than ASA score (c-statistic = 0.580 and p = 0.003). CONCLUSIONS mFI-5 and AmFI-5 represent potential predictors of procedure-related complications in unruptured aneurysm patients. After further validation, integration of these tools into clinical workflows may optimize patients for intervention.

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.

Postoperative Outcomes of Elective Pancreatic Surgery in a Low-Volume Academic Surgical Clinic

2013 ◽  
Vol 6 (2) ◽  
pp. 106-111
Author(s):  
Alexander E. Julianov ◽  
Anatoli G. Karashmalakov ◽  
Ivan G. Rachkov ◽  
Yonko P. Georgiev
Keyword(s):  
Pancreatic Surgery ◽  
Postoperative Mortality ◽  
Postoperative Outcome ◽  
High Volume ◽  
Postoperative Outcomes ◽  
Benign Tumors ◽  
Pancreatic Resections ◽  
Low Volume ◽  
Age Range ◽  
Surgical Clinic

Summary According to the volume-outcome concept the postoperative outcome after major pancreatic surgery in high-volume institutions compares favorably to low- volume centers. However, it is not clear whether this is applicable to all low-volume institutions nowadays. The aim of the study was to evaluate the postoperative outcome after major elective pancreatic surgery in a low- volume academic surgical clinic. All consecutive elective major pancreatic cases operated within a 10-year period till October 2013 have been retrospectively reviewed. During the studied period, 36 patients (15 females, 21 males, mean age 54 years, age range 37-76) were scheduled for elective pancreatic surgery and underwent pancreatic resection (n=31, 18 proximal and 13 distal pancreatic resections) or complete pancreatic duct drainage procedure (n=5). Eleven patients had chronic pancreatitis and 25 patients had malignant or benign tumors. Vascular or adjacent organ resection was performed in 9 patients (29% of resections). The overall postoperative morbidity was 36% (n=13), and complications requiring re-operation occurred in 5 patients (14%). The median postoperative hospital stay was 11 days for patients without complications vs. 25 days for patients with any complication. There was no 60- day postoperative mortality or hospital readmission. Major elective pancreatic surgery can be safely performed today in a low-volume academic general surgical clinic, with postoperative outcomes similar to those reported by high-volume centers.

scholarly journals The Impact of Frailty on Morbidity and Mortality following Open Emergent Colectomies

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Dominick V. Congiusta ◽  
Prashanth Palvannan ◽  
Aziz M. Merchant
Keyword(s):  
Care Setting ◽  
Frailty Index ◽  
Acute Care Setting ◽  
Improvement Program ◽  
Mortality And Morbidity ◽  
National Quality ◽  
American College Of Surgeons ◽  
Modified Frailty Index ◽  
The Impact ◽  
The Relationship

Background. Elderly and frail patients undergo open emergency colectomies and are at greater risk for complications. The relationship between frailty and open emergent colectomies is yet unexplored.Objective. The purpose of this study was to evaluate the relationship between frailty and outcomes after open emergent colorectal surgery.Design. Using the American College of Surgeons National Quality Improvement Program database, a validated modified frailty index was used, along with logistic regression, to assess the relationship between frailty and outcomes.Main Outcome Measures. Outcomes included mortality (primary), Clavien-Dindo Complication Grade >3, reintubation, ventilator >48 hours, and reoperation (secondary).Results. The rates for 30-day mortality, Clavien-Dindo Grade >3, reintubation, ventilator > 48 hours, and reoperation in our cohort were 16.6%, 36.9%, 8.6%, 23.9%, and 15.0%, respectively. There was a statistically significant increase in prevalence of all outcomes with increasing frailty.Limitations. A causal relationship between frailty and complications cannot be established in a retrospective analysis. Also, extrapolation of our data to reflect outcomes beyond 30 days must be done with caution.Conclusions. Frailty is a statistically significant predictor of mortality and morbidity after open emergent colectomies and can be used in an acute care 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

The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury

2020 ◽  
Vol 86 (11) ◽  
pp. 1596-1601
Author(s):  
Brett M. Tracy ◽  
Margo N. Carlin ◽  
James W. Tyson ◽  
Mara L. Schenker ◽  
Rondi B. Gelbard
Keyword(s):  
Traumatic Brain Injury ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Brain Injury ◽  
Frailty Index ◽  
Kidney Injury ◽  
Care Hospital ◽  
Improvement Program ◽  
Multivariable Logistic Regression ◽  
Modified Frailty Index

Background Frailty has been studied extensively in trauma, but there is minimal research detailing its impact on traumatic brain injury (TBI). We hypothesized that the 11-item modified frailty index (mFI-11) would predict complications and discharge outcomes in patients with TBI. Methods A retrospective review of our trauma quality improvement program (TQIP) registry was conducted for all patients with TBI. The mFI-11 score was calculated for each patient. Multivariable logistic regression was used to assess the relationship between mFI-11 and cardiovascular, infectious, pulmonary, renal, thromboembolic, and unplanned complications (ie, unplanned intensive care unit [ICU] admission, intubation, or return to the operating room). Results There were 2352 patients with TBI of whom 61.6% (n = 1450) were not frail, 19.3% (n = 454) were mildly frail, and 19.1% (n = 448) were moderately to severely frail. Higher frailty scores were associated with increasing age ( P < .0001) and decreasing injury severity score [ISS] ( P = 0.001). Higher frailty scores also correlated with increasing rates of a skilled nursing facility/long-term acute care hospital/rehabilitation discharge ( P = .0002). On multivariable logistic regression adjusting for age, Glasgow Coma Scale (GCS) score, ISS, mechanism, and sex, moderate to severe frailty increased the odds of acute kidney injury (odds ratio [OR] 2.06, 95% CI 1.07-3.99, P = .03) and any unplanned event (OR 1.6, 95% CI 1.1-2.3, P = .01). Conclusion Frailty measured by the mFI-11 is associated with greater rates of discharge to unfavorable locations and increased odds of acute kidney injury and unplanned events among patients with TBI. These findings suggest that frail patients with TBIs require greater vigilance to avoid such unanticipated outcomes.

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