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A modified frailty index to assess morbidity and mortality after lobectomy
Athanasios Tsiouris1, Zane T Hammoud, Vic Velanovich
1Department of Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA. athtsiouris@hotmail.com
Background:
Frailty has yet to be explored as a risk factor for thoracic surgery. We hypothesized that our modified frailty index (mFI) may be a predictor of morbidity and mortality following lobectomy.
Materials:
National Surgical Quality Improvement Program (NSQIP) participant use files were reviewed (2005-2010). Patients undergoing lobectomy were identified based on Current Procedural Terminology code 32480. We used an mFI with 11 variables, based on mapping the Canadian Study of Health and Aging Frailty Index to the NSQIP comorbidities. Data were analyzed using χ(2) test, independent sample t-test, Jonckheere-Terpstra test, and logistic regression.
Results:
Of 1940 open lobectomy patients identified, morbidity and mortality uniformly increased as the mFI increased; 14.9% of patients (75/504) with mFI of 0 had at least one complication, compared with 32% of patients (91/284) with mFI of 0.27 (P < 0.001). An mFI of 0 was associated with a mortality rate of 1% (5/504), compared with 5.6% (16/284) for mFI of 0.27 (P < 0001). Failure to wean from the ventilator, reintubation, surgical site infections, pneumonia, and Clavien 4 and above complications occurred in 1.8% (9/504), 2.6% (13/504), 2.2% (11/504), 5.4% (27/504), and 4.2% (21/504), respectively, in patients with an mFI of 0, compared with 7.4% (21/284), 7% (22/284), 3.2% (9/284), 10.9% (31/284), and 14.4% (41/284), respectively, in patients with mFI of 0.27.
Conclusions:
This study demonstrates that the mFI may identify patients at higher risk for morbidity and mortality post-lobectomy. With the aging population, preoperative selection is important in minimizing morbidity and mortality and improving risk stratification for informed decision-making.
Insights
The modified frailty index (mFI) effectively predicts higher morbidity and mortality risks in patients undergoing lobectomy, aiding in preoperative risk stratification for better surgical outcomes.
Area of Science:
- Thoracic Surgery
- Geriatric Medicine
- Surgical Outcomes Research
Background:
- Frailty is an understudied risk factor in thoracic surgery.
- A modified frailty index (mFI) was developed to assess frailty in this context.
- The mFI's predictive value for post-lobectomy outcomes requires investigation.
Purpose of the Study:
- To investigate the modified frailty index (mFI) as a predictor of morbidity and mortality after lobectomy.
- To establish the relationship between mFI scores and adverse outcomes in thoracic surgery patients.
Main Methods:
- Utilized the National Surgical Quality Improvement Program (NSQIP) database (2005-2010).
- Identified 1940 patients who underwent open lobectomy (CPT code 32480).
- Applied an 11-variable mFI, mapped from the Canadian Study of Health and Aging Frailty Index to NSQIP comorbidities, and analyzed data using logistic regression.
Main Results:
- Morbidity and mortality rates significantly increased with higher mFI scores (P < 0.001).
- Patients with mFI of 0.27 had higher complication rates (32%) and mortality (5.6%) compared to those with mFI of 0 (14.9% and 1%, respectively).
- Specific complications like ventilator failure, reintubation, pneumonia, and severe complications (Clavien ≥4) were more frequent in frail patients.
Conclusions:
- The modified frailty index (mFI) effectively identifies patients at increased risk for morbidity and mortality post-lobectomy.
- Preoperative frailty assessment is crucial for improving risk stratification and informed decision-making in an aging population undergoing thoracic surgery.
