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VOLUME 28 , ISSUE 11 ( November, 2024 ) > List of Articles

Original Article

Effect of Frailty on Postoperative Outcomes Following Major Abdominal Surgeries: A Prospective Observational Study

Malini Joshi, Shilpushp J Bhosale, Jayant Pandhare, Resham Rathod, Sohan L Solanki, Atul P Kulkarni

Keywords : Frailty, Major abdominal cancer surgeries, Postoperative complications

Citation Information : Joshi M, Bhosale SJ, Pandhare J, Rathod R, Solanki SL, P Kulkarni A. Effect of Frailty on Postoperative Outcomes Following Major Abdominal Surgeries: A Prospective Observational Study. Indian J Crit Care Med 2024; 28 (11):1038-1043.

DOI: 10.5005/jp-journals-10071-24839

License: CC BY-NC 4.0

Published Online: 30-10-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Frailty poses unique challenges for patients undergoing major cancer surgeries due to their extreme vulnerability to physiological stressors and can be an important factor in determining postoperative outcomes. Aims and objective: The objective of the study was to determine the incidence of frailty in patients undergoing major abdominal cancer surgeries and identify the risk factors predicting poor outcomes. Materials and methods: This was a prospective observational study conducted following institutional ethics approval and CTRI registration. We included 308 adult patients who underwent major abdominal cancer surgeries over two years. The preoperative frailty score was calculated using the 11-point modified frailty index score (mFI scale). Patients with a mFI score ≥ 3 points were considered frail. Clinical outcomes such as postoperative complications (Clavien–Dindo grades III and IV), surgical site infections, need for vasopressors, mechanical ventilation, acute kidney injury (AKI), length of ICU and hospital stay, and mortality at 30 days were recorded. Results: The overall incidence of frailty according to the mFI scale was 8.1%. Age and higher American Society of Anesthesiology (ASA) status were significantly associated with frailty (OR –1.073, p < 0.001, and OR –10.220, p < 0.001) respectively. Frailty was an independent predictor of major postoperative complications (OR –8.147, 95%; CI –2.524–26.292, p < 0.001). Frailty was also significantly associated with an increased duration of mechanical ventilation and length of stay (p < 0.001). Conclusion: The modified frailty index (mFI) score remains a strong predictor of postoperative complications in patients undergoing major abdominal cancer surgeries and can help optimize risk factors to minimize complications.


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  1. Ethun CG, Bilen MA, Jani AB, Maithel SK, Ogan K, Master VA. Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA Cancer J Clin 2017;67(5):362–377. DOI: 10.3322/caac.21406.
  2. Stones J, Yates D. Clinical risk assessment tools in anaesthesia. BJA Educ 2019;19(2):47–53. DOI: 10.1016/j.bjae.2018.09.009
  3. Copeland GP, Jones D, Walters M. POSSUM: A scoring system for surgical audit. Br J Surg 1991;78(3):355–360. DOI: 10.1002/bjs.1800780327.
  4. Sahara K, Paredes AZ, Merath K, Tsilimigras DI, Bagante F, Ratti F, et al. Evaluation of the ACS NSQIP surgical risk calculator in elderly patients undergoing hepatectomy for hepatocellular carcinoma. J Gastrointest Surg 2020;24(3):551–559. DOI: 10.1007/s11605-019- 04174-4.
  5. Mogal H, Vermilion SA, Dodson R, Hsu FC, Howerton R, Shen P, et al. Modified frailty index predicts morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol 2017;24(6):1714–1721. DOI: 10.1245/s10434-016-5715-0.
  6. Agarwal V, Thomas MJ, Joshi R, Chaudhari V, Bhandare M, Mitra A, et al. Improved outcomes in 394 pancreatic cancer resections: The impact of enhanced recovery pathway. J Gastrointest Surg 2018;22(10):1732–1742. DOI: 10.1007/s11605-018-3809-7.
  7. Sandini M, Pinotti E, Persico I, Picone D, Bellelli G, Gianotti L. Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery. BJS Open 2017;1(5):128–137. DOI: 10.1002/bjs5.22.
  8. Howell SJ, Nair S. Measuring frailty in the older surgical patient: The case for evidence synthesis. Br J Anaesth 2021;126(4):763–767. DOI: 10.1016/j.bja.2021.01.002.
  9. Jagathkar G. Elderly in the ICU. Indian J Crit Care Med 2023;27(3):157–158. DOI: 10.5005/jp-journals-10071-24422.
  10. Vermillion SA, Hsu FC, Dorrell RD, Shen P, Clark CJ. Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients. J Surg Oncol 2017;115(8):997–1003. DOI: 10.1002/jso.24617.
  11. Kalaiselvan MS, Yadav A, Kaur R, Menon A, Wasnik S. Prevalence of frailty in ICU and its impact on patients’ outcomes. Indian J Crit Care Med 2023;27(5):335–341. DOI: 10.5005/jp-journals-10071- 24456.
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