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Yim THJYZ, Tan KY. Functional Outcomes after Abdominal Surgery in Older Adults - How concerned are we about this? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108347. [PMID: 38657374 DOI: 10.1016/j.ejso.2024.108347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Amidst trends of a rapidly ageing population with better surgical outcomes for geriatric patients, it is imperative to consider outcome measures beyond mortality and morbidity rates. In fact, the preservation of one's postoperative function has been cited as a key priority for older adults and is a crucial determinant of postoperative independence and survival. This review aims to examine the prevalence of perioperative function reporting amongst older surgical patients undergoing elective major abdominal surgery for cancer. We systematically reviewed studies from inception to December 2023 for studies which focused on the outcomes of older surgical patients undergoing elective major abdominal surgery for cancer. Relevant citations were screened (title, abstract and full article review) based on the inclusion and exclusion criteria. 103 studies were included, of which only 31 studies consisting of 20885 participants reported perioperative function. While the nominal number of studies which report perioperative function has been on a steady rise since 2018, the proportion of studies which do so remains low. Postoperative function is three times less likely to be reported than preoperative function, suggesting that functional recovery is not sufficiently assessed. This suggests that there is still a poor uptake of functional recovery as an outcome measure amongst surgeons, and any increase in perioperative function reporting is likely due to the increased administration of frailty assessments. These findings should urge greater efforts in quantifying and enabling functional recovery to improve the clinical outcomes and quality of care for older surgical patients.
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Affiliation(s)
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central Singapore 768828.
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Ju G, Liu X. Prognostic nutritional index and modified frailty index, independent risk factors for recompression in elderly patients with osteoporotic vertebral compression fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1518-1523. [PMID: 37922016 DOI: 10.1007/s00586-023-08016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND To identify some clinical and laboratory independent risk factors for postoperative recompression among elderly osteoporotic vertebral compression fractures (OVCF) patients. METHODS A retrospective analysis was conducted on 287 elderly OVCF patients after percutaneous vertebroplasty (PVP). Relevant risk factors for recompression were screened and further analyzed through multivariate logistic regression. RESULTS Within postoperative 1 year, recompression had occurred in 72 patients, with an incidence of 25.1% (72/287). Multivariate logistic analysis indicated that mean spinal BMD < - 2.85 (OR: 4.55, 95%CI 2.22-9.31, P < 0.001), ODI ≥ 68.05% (OR: 6.78, 95%CI 3.16-14.55, P < 0.001), PNI score < 43.1 (OR: 2.81, 95%CI 1.34-5.82, P = 0.005), and mFI score ≥ 0.225 (OR: 8.30, 95%CI 3.14-21.95, P < 0.001) were four distinct risk factors that independently contributed to postoperative recompression. CONCLUSIONS Spinal BMD, ODI, PNI and mFI independently predict recompression in OVCF patients after PVP treatment.
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Affiliation(s)
- Gang Ju
- Department of Orthopedics, The Afliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, No. 366 Taihu Road, Taizhou City, 225300, Jiangsu Province, China.
| | - Xiaoqing Liu
- Chengdong Street Community Medical Service Center, Taizhou, China
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Miao X, Guo Y, Chen Y, Xu X, Ding L, Hu J, Zhao K, Lu J, Zhu H, Chen L, Zhu S, Xu Q. Exploration of frailty trajectories and their associations with health outcomes in older gastric cancer survivors undergoing radical gastrectomy: A prospective longitudinal observation study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107934. [PMID: 38160495 DOI: 10.1016/j.ejso.2023.107934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/21/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Frailty is commom among gastric cancer survivors and increases the burden of care. AIMS Our aims were to identify the frailty trajectories and investigate their associations with health outcomes in older gastric cancer survivors. METHODS We finally recruited 381 patients aged ≧60 who underwent radical gastrectomy and recorded frailty at discharge from the hospital, 1, 3, 6, and 12 months after surgery. Growth mixture modeling was used to investigate the frailty trajectories and linear regression models were used to examine their associations with health outcomes. RESULTS Three classes of frailty trajectories were identified: the "improving frailty", "maintaining frailty" and "deteriorating frailty". Compared with class 1, patients who followed class 2 and class 3 frailty trajectories were more likely to have more severe disability (β = -14.22, 95 % CI: -17.92, -10.61, P < 0.001; β = -48.34, 95 % CI: -52.25, -44.42, P < 0.001), worse quality of life (β = 10.89, 95 % CI: 7.71,14.08, P < 0.001; β = 34.82, 95 % CI: 31.46, 38.19, P < 0.001), and more frequency readmission within 1 year (β = 1.02, 95 % CI: 0.98, 1.06, P < 0.001; β = 2.10, 95 % CI: 2.01, 2.14, P < 0.001) after controlling potential confounders. However, class 2 and class 3 have no significant difference from class 1 in the total hospitalization costs (β = 1672.12, 95 % CI: -7145.95, 10496.19, P = 0.709; β = 7651.60, 95 % CI: -1670.28, 16793.47, P = 0.107). CONCLUSIONS Our study suggested the significant prognostic heterogeneity in frailty trajectories, and what we need to do is to identify patients with heterogeneous trajectory and intervene in them to reduce adverse outcomes, promote rational use of resources, and reduce the burden of care.
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Affiliation(s)
- Xueyi Miao
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Yinning Guo
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Yimeng Chen
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Xinyi Xu
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Lingyu Ding
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Jieman Hu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Jinling Lu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Li Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China.
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Liang H, Hu A. Frailty and long-term survival of patients with gastric cancer: a meta-analysis. Front Oncol 2023; 13:1239781. [PMID: 37810985 PMCID: PMC10552761 DOI: 10.3389/fonc.2023.1239781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Background The relationship between frailty and the long-term clinical outcome of gastric cancer (GC) patients has not yet been established, although frailty is associated with a poor short-term outcome. The impact of frailty on long-term survival of GC patients was investigated through a systematic review and meta-analysis. Methods Observational studies with longitudinal follow-ups for a minimum of one year were identified through a search of the PubMed, Embase, Cochrane Library, and Web of Science databases, in accordance with the objective of the meta-analysis. Combining the findings was achieved using a random-effects model, which accounted for inter-study heterogeneity. Results Ten datasets from nine cohort studies were included, which involved 7613 patients with GC. A total of 2074 patients (27.2%) were with frailty at baseline, and the mean follow-up duration was 48.1 months. A pooled analysis of the results showed that frailty was linked to a poor long-term overall survival in GC patients (risk ratio [RR]: 1.65, 95% confidence interval [CI]: 1.27 to 2.13, p < 0.001; I2 = 80%). Sensitivity analysis showed consistent results in older patients (≥ 65 years, RR: 1.51, p = 0.002) and the oldest old (≥ 80 years, RR: 1.41, p = 0.01). In addition, frailty was also associated with poor long-term progression-free survival (RR: 1.65, 95% CI: 1.39 to 1.96, p < 0.001; I2 = 0%) and disease-specific survival (RR: 1.71, 95% CI: 1.23 to 2.37, p = 0.001; I2 = 4%). Conclusion Frailty is associated with poor long-term survival of patients with GC.
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Affiliation(s)
- Hongliang Liang
- Department of Gastroenterology, Liaocheng People’s Hospital, Liaocheng, China
| | - Aiping Hu
- Department of Oncology, Liaocheng Tumor Hospital, Liaocheng, China
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Zhou Y, Ge Y, Liu J, Shen W, Gu H, Cheng G. Modified Frailty Index and Albumin-Fibrinogen Ratio Predicts Postoperative Seroma After Laparoscopic TAPP. Clin Interv Aging 2023; 18:1397-1403. [PMID: 37637752 PMCID: PMC10460205 DOI: 10.2147/cia.s418338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
Background Postoperative seroma is the most common minor complication after inguinal hernia repair surgery and can have negative consequences. The objective of this study was to identify potential risk factors for postoperative seroma. Methods This study consecutively included 354 elderly patients with inguinal hernia who underwent laparoscopic Transabdominal preperitoneal Patch Plasty (TAPP). Seroma diagnosis was conducted by the same experienced surgeon based on the physical examinations combined with ultrasound. Risk factors for seroma were identified through univariate analysis and subsequently included in the binary multivariate logistic regression model. Results A total of 40 patients experienced postoperative complications of seroma, with an incidence rate of 11.3% (40/354). The binary logistic regression analysis revealed that obesity (OR: 2.98, 95% CI: 1.20-7.41, P = 0.018), disease duration ≥ 4.5 years (OR: 4.88, 95% CI: 2.14-11.18, P < 0.001), albumin-fibrinogen ratio (AFR) level < 9.25 (OR: 6.13, 95% CI: 2.00-18.76, P = 0.001), and modified frailty index (mFI) score ≥ 0.225 (OR: 6.38, 95% CI: 2.69-15.10, P < 0.001) were four independent risk factors for postoperative seroma. Conclusion Obesity, prolonged disease duration, decreased AFR level, and increased mFI score independently predict postoperative seroma after laparoscopic TAPP.
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Affiliation(s)
- Yang Zhou
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
| | - Yongxiang Ge
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
| | - Jian Liu
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
| | - Weijian Shen
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
| | - Hailiang Gu
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
| | - Guochang Cheng
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
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Ou Y, Wang H, Yang L, Jiang W. Frailty is associated with an increased risk of postoperative pneumonia in elderly patients following surgical treatment for lower-extremity fractures: A cross-sectional study. Medicine (Baltimore) 2023; 102:e33557. [PMID: 37058022 PMCID: PMC10101317 DOI: 10.1097/md.0000000000033557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
Elderly patients with lower-extremity fractures are at high risk of postoperative pneumonia (POP) after surgery due to longtime bed rest. This study aimed to explore whether preoperative frailty is an independent risk factor for POP in elderly patients undergoing surgical treatment for lower-extremity fractures. The study adopted a cross sectional design with 568 patients (≥60 years) admitted to a tertiary hospital in China from January 1, 2021 to June 30, 2022, for surgical intervention of a significant lower-extremity fracture. Preoperative frailty was assessed using the CFS (Clinical Frailty Scale). POP was assessed based on the classic diagnostic criteria reported in previous studies. Univariate and multiple logistic regression analyses were conducted to determine the impacts of preoperative frailty on POP. Of the 568 elderly patients, 65 (11.4%) developed pneumonia during postoperative hospitalization. There were significant differences among gender, hypoproteinemia, type of anesthesia, history of chronic obstructive pulmonary disease (COPD), and CFS scores. Multiple regression analysis revealed that the risk of POP in vulnerable, mildly frail, and severely frail patients increased by 2.38 times (P = .01, 95% CI [1.22-1.91]), 3.32 (P = .00, 95% CI [2.39-5.61]), and 5.36 (P = .00, 95% CI [3.95-6.52]), significantly. 12.8% of patients with hip fractures and 8.9% of patients with other main types of lower-extremity fractures developed POP. However, the difference between hip and non-hip fractures was not statistically significant (P > .05). Preoperative frailty increases the risk of POP in elderly patients after surgical treatment of main lower-extremity fractures. The severer the preoperative frailty is, the higher the risk of preoperative pneumonia is in elderly patients with lower-extremity fractures. CFS is simple and feasible for the assessment of frailty in elderly patients with lower-extremity fractures. Preoperative frailty assessment and appropriate management strategies should be considered in the perioperative management of elderly patients with lower-extremity fractures.
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Affiliation(s)
- Yili Ou
- Department of Orthopedics, Deyang People’s Hospital/Orthopedic Center of Deyang City, Deyang, China
| | - Hong Wang
- Department of Orthopedics, Deyang People’s Hospital/Orthopedic Center of Deyang City, Deyang, China
| | - Ling Yang
- Department of Orthopedics, Deyang People’s Hospital/Orthopedic Center of Deyang City, Deyang, China
| | - Wei Jiang
- Department of Orthopedics, Deyang People’s Hospital/Orthopedic Center of Deyang City, Deyang, China
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Significance of Preoperative Pulmonary Function on Short- and Long-Term Outcomes Following Gastrectomy for Gastric Cancer. J Gastrointest Surg 2023; 27:866-877. [PMID: 36658384 PMCID: PMC9851588 DOI: 10.1007/s11605-023-05582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/25/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preoperative pulmonary function assessment is useful for selecting surgical candidates and operative methods and assessing the risk of postoperative pulmonary complications. However, few studies have investigated the relationship between preoperative pulmonary function and short- and long-term outcomes in patients who underwent gastrectomy for gastric cancer. METHODS Of the 1040 patients with gastric cancer (stages I-III) who had undergone R0 gastrectomy between 2009 and 2020, 750 who underwent preoperative spirometry were included. Restrictive ventilatory impairment was defined as a vital capacity of the predicted value (%VC) < 80%, while obstructive ventilatory impairment was defined as forced expiratory volume in one second (FEV1%) < 70%. Postoperative complications were assessed using the Clavien-Dindo (CD) classification. The relationship between clinical factors, including %VC, FEV1%, severe postoperative complications (CD ≥ 3b), overall survival (OS), and relapse-free survival, were assessed. RESULTS The mean age of the 750 patients was 68 ± 10.5 years. Severe postoperative complications were observed in 25 (3.3%) patients and were significantly associated with FEV1% < 70% in the univariate analysis. The 5-year OS was 72.5%. Multivariate analysis showed that the cancer stage, age > 75 years, preoperative comorbidities, %VC < 80%, total gastrectomy, severe postoperative complications, and postoperative adjuvant chemotherapy were the significant independent factors affecting OS. Pneumonia was significantly associated with %VC < 80%. CONCLUSIONS FEV1% < 70%was associated with the development of severe postoperative complications, while %VC < 80% was associated with poor OS independent of the cancer stage because of death from pneumonia. Spirometry helps surgeons and patients discuss the risks and benefits of surgery.
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Miyauchi W, Matsunaga T, Sakano Y, Makinoya M, Shimizu S, Shishido Y, Miyatani K, Sakamoto T, Hasegawa T, Fujiwara Y. Usefulness of the Modified Frailty Index for Predicting Pneumonia Occurrence After Esophagectomy. Yonago Acta Med 2023; 66:1-6. [PMID: 36820293 PMCID: PMC9937958 DOI: 10.33160/yam.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/16/2022] [Indexed: 01/18/2023]
Abstract
Background Esophagectomy is an invasive and complication-prone surgical procedure. Therefore, a tool that can predict the occurrence of postoperative complications may be useful for perioperative management. In this study, we investigated whether the modified frailty index (mFI) could be a useful tool for predicting the postoperative complications of esophagectomy. Methods In this study, 162 patients who underwent curative esophagectomy for esophageal squamous cell carcinoma from 2004 to 2019 at our institution were included. The patients were divided into the high mFI (≥ 0.27) and low mFI (< 0.27) groups, and the short-term postoperative outcomes of each group were examined retrospectively. Results Regarding background factors, age and the American Society of Anesthesiologists physical status classification were significantly higher in the high mFI group (P = 0.049 and P = 0.002, respectively); however, the other items were not significantly different between the two groups. Regarding surgical outcomes, no significant differences in operative time, blood loss, and hospital stay were observed between the two groups. Regarding postoperative complications, pneumonia was significantly more common in the high mFI group (P = 0.035). In multivariate analysis, high mFI (P = 0.034) was an independent predictor of pneumonia, along with operative time ≥ 613 min (P = 0.03) and preoperative BMI < 20.48 (P = 0.006). Conclusion The mFI is useful for predicting pneumonia after esophagectomy.
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Affiliation(s)
- Wataru Miyauchi
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yu Sakano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Masahiro Makinoya
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shota Shimizu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Toshimichi Hasegawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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The 5-factor modified Frailty Index (mFI-5) predicts adverse outcomes after elective Anterior Lumbar Interbody Fusion (ALIF). NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 13:100189. [PMID: 36579159 PMCID: PMC9791584 DOI: 10.1016/j.xnsj.2022.100189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Background The 5-factor modified frailty index (mFI-5) has been shown to be a concise and effective tool for predicting adverse events following various spine procedures. However, there have been no studies assessing its utility in patients undergoing anterior lumbar interbody fusion (ALIF). Therefore, the aim of this study was to analyze the predictive capabilities of the mFI-5 for 30-day postoperative adverse events following elective ALIF. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried from 2010 through 2019 to identify patients who underwent elective ALIF using Current Procedural Terminology (CPT) codes in patients over the age of 50. The mFI-5 score was calculated using variables for hypertension, congestive heart failure, comorbid diabetes, chronic obstructive pulmonary disease, and partially or fully dependent functional status which were each assigned 1 point. Univariate analysis and multivariate logistic regression models were utilized to identify the associations between mFI-5 scores, and 30-day rates of overall complications, readmissions, reoperations, and mortality. Results 11,711 patients were included (mFI-5=0: 4,026 patients, mFI-5=1: 5,392, mFI-5=2: 2,102, mFI-5=3+: 187. Multivariate logistic regression revealed that mFI-5 scores of 1 (OR: 2.2, CI: 1.2-4.2, p=0.02), 2 (OR: 3.6, CI: 1.8-7.3, p<0.001), and 3+ (OR: 7.0, CI: 2.5-19.3, p<0.001) versus a score of 0 were significant predictors of pneumonia. An mFI-5 score of 2 (OR: 1.3; CI: 1.01-1.6, p=0.04), and 3+ (OR: 1.9; CI: 1.1-3.1; p=0.01) were both independent predictors of related readmissions. An mFI score of 3+ was an independent predictor of any complication (OR: 1.5, CI: 1.01-2.2, p=0.004), UTI (OR: 2.4, CI: 1.1-5.2, p=0.02), and unplanned intubation (OR: 4.5, CI: 1.3-16.1, p=0.02). Conclusions The mFI-5 is an independent predictor for 30-day postoperative complications, readmissions, UTI, pneumonia, and unplanned intubations following elective ALIF surgery in adults over the age of 50.
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Wang X, Sun Y, Wang P, Jie Y, Liu G, Gong D, Fan Y. Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis. Front Oncol 2022; 12:972287. [PMID: 36387139 PMCID: PMC9659614 DOI: 10.3389/fonc.2022.972287] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Frailty as a common geriatric syndrome can affect the clinical outcomes in patients with gastric cancer. However, the impact of frailty on survival and readmission patients with gastric cancer has not been well-characterised. Objectives To investigate the impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy by conducting a meta-analysis. Methods Eligible studies were identified by searching the PubMed, Web of Science, Cochrane Library, and Embase databases until 2 September 2022. Observational studies that evaluated the value of frailty in predicting adverse outcomes in gastric cancer patients undergoing gastrectomy were included. The outcomes of interest were overall survival, disease-specific survival (death from gastric cancer), and readmission. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were pooled to calculate the association of frailty with adverse outcomes. Results Eight studies reported on nine articles with 2,792 patients with gastric cancer were included. A fixed-effect meta-analysis indicated that frailty was associated with a reduced in-hospital overall survival (HR 2.08; 95% CI 1.46–2.95), long-term overall survival (HR 1.84; 95% CI 1.37–2.47), and disease-specific survival (HR 1.94; 95% CI 1.34–2.83). In addition, frailty was associated with increased risk of readmission within 1 year (HR 3.63; 95% CI 1.87–7.06). Conclusions Frailty was associated with a reduced overall survival and disease-specific survival and an increased risk of readmission in patients with gastric cancer undergoing gastrectomy. Frail status may play an important role in the risk stratification of gastric cancer after gastrectomy.
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Affiliation(s)
- Xiaoyan Wang
- Department of Gastroenterology, The Suqian Clinical College of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Yimeng Sun
- Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Pei Wang
- Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yu Jie
- Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Guodong Liu
- Department of General Surgery, The Suqian Clinical College of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Dandan Gong
- Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
- *Correspondence: Yu Fan, ; Dandan Gong,
| | - Yu Fan
- Cancer Institute, The Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
- *Correspondence: Yu Fan, ; Dandan Gong,
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