Preoperative frailty assessment in older patients with colorectal cancer: use of clinical and radiological tool.

PURPOSE: The Memorial Sloan Kattering Frailty Index (MSK-FI) and the Skeletal Muscle Index (SMI) have recently gained attention as markers of frailty and decreased physiologic reserve, and are promising as predictors of adverse postoperative outcomes in patients undergoing oncologic surgery. The objective of this study was to establish the prognostic accuracy of these indexes in a cohort of patients with colorectal cancer subjected to surgical intervention. METHODS: We performed an observational study including all patients older than 60 years, subjected to colorectal cancer surgery between January 2010 and May 2020, and stratified our cohort based on the presence of frailty, as defined by MSK-FI ≥ 3. Computed tomography was used to calculate SMI, using a standardized institutional protocol. A multivariable analysis was used to study the association between these novel indexes with adverse postoperative outcomes in our cohort. RESULTS: A total of 216 patients were included. Among these, 56 (26%) qualified as frail and 132 (62%) had a low SMI. On multivariable analysis (adjusted by patient and intraoperative characteristics), frailty was associated with increased risk of having a major postoperative complication (OR 29.78, 95%CI 10.36-85.71) and increased admission to the intensive care unit (OR 4.99, 95%CI 1.55-16.06), while both frailty and low SMI were associated with prolonged length of stay (OR 11.22, 95%CI 8.91-13.53 and OR 0.14, 95% CI 0.06-0.20, respectively). CONCLUSION: MSK-FI ≥ 3 and low SMI are associated with adverse postoperative outcomes in elderly patients undergoing colorectal cancer surgery. Implementing this practical tool in routine clinical practice, may help identify patients that would benefit from surgical prehabilitation and preoperative optimization to improve outcomes.

Frailty index as a predictive preoperative tool in the elder population undergoing major abdominal surgery: a prospective analysis of clinical utility.

PURPOSE: The geriatric population has increased considerably in the last decades. Such increases come along with new challenges for surgical practitioners, who now face a risen number of frail patients in need of major operations. The value of frailty indexes in this setting has been discussed recently. This study assessed the modified Rockwood frailty index (mRFI) as a predictive tool for postoperative complications in older adults subjected to major abdominal operations and correlated it with other scores widely utilized for this purpose. METHODS: We performed a prospective study utilizing the mRFI including all patients older than 65 years subjected to major abdominal surgery between May 2017 and May 2019 in a third-level academic center. A comparison between frail (mRFI >0.25) and non-frail patients (mRFI <0.25) was performed. We performed logistic regression to identify predictors of postoperative complications and 30-day mortality. We analyzed the correlation between mRFI and ACS-NSQIP, P-POSSUM, PMP, and Charlson score risk calculators. RESULTS: One hundred forty patients were included in our study, of whom 49 (35%) were identified as frail. Frail patients demonstrated significantly prolonged hospital stay (p<.0001), ICU admission rates (p=0.004), hospital readmissions (p=0.007), and higher mortality rates (p=0.02). Our univariate analysis associated frailty (mRFI>0.25), ASA >III, increased age, and BMI with postoperative complications. In our multivariate analysis, frailty remained an independent predictor for postoperative complications (OR 6.38, 95% CI [2.45-16.58], p<0.001). Frailty was also associated with length of stay (LOS) regardless of the type of surgery (OR 3.35, 95% CI [0.37-6.33], p= 0.03). mRFI>0.25 demonstrated a sensitivity (Se) of 70% and specificity (Sp) 67% with area under the curve (AUC) 0.75 for perioperative complications, Se 69% and Sp 70% with AUC 0.74 for ICU admissions, and Se 83% and Sp 68% with AUC 0.83 for mortality. CONCLUSION: Frail patients demonstrated significantly prolonged hospital stay, ICU admission rates, hospital readmissions, and higher mortality rates. mRFI is an independent predictor for perioperative complications with a Se of 70% and Sp 67% and AUC 0.75.