Modified Frailty Index is Useful in Predicting Non-home Discharge in Elderly Patients with Gastric Cancer Who Undergo Gastrectomy.

ABSTRACT

BACKGROUND: Development of laparoscopic gastrectomy and the Enhanced Recovery After Surgery (ERAS) protocol enable early discharge to home of patients with gastric cancer (GC). However, a significant proportion of patients are still discharged to inpatient facilities after surgery. We aimed to identify predictive factors of non-home discharge in patients with GC who undergo gastrectomy. METHODS: We enrolled 517 patients with histopathologically confirmed diagnosis of GC who underwent gastrectomy. RESULTS: The number of patients with non-home discharge was 23 (4.4%), and non-home discharge was only observed in patients with GC aged ≥65 years. Patients were divided into the mFIHigh (≥0.272) and mFILow (<0.272) groups according to the cut-off value determined by ROC analysis. The mFIHigh classification was significantly more frequent in patients aged ≥75 years, who underwent either total or proximal partial gastrectomy, who underwent limited lymph node dissection, and with non-home discharge than in patients aged <75 years (p = 0.0002), those who underwent distal partial gastrectomy (p = 0.032), those who underwent standard lymph node dissection (p = 0.036), and those without non-home discharge (p = 0.0071). Multivariate analysis revealed mFI as an independent predictive indicator of non-home discharge, along with postoperative complications and surgical approach, in patients with GC aged ≥65 years. The frequency of patients with non-home discharge was significantly associated with the number of these three predictive factors in GC patients aged ≥65 years (p < 0.0001). CONCLUSIONS: The combination of mFI, postoperative complications, and surgical approach is useful for predicting non-home discharge in patients aged ≥65 years who underwent gastrectomy for GC.