Frailty Predicts Severe Postoperative Complication after Elective Hepatic Resection

Frail patients are likely to suffer from postoperative complication, but this assumption has not been well confirmed.

This study aims to clarify the importance of frailty in patients undergoing hepatectomy for predicting severe postoperative complications.

One hundred and forty-three patients aged >65 years undergoing hepatectomy between 2011 and 2016 were enrolled in this study. The relevance of frailty versus sarcopenia for postoperative outcome was assessed. We defined clinical frailty (CF) as a CF scale >4. Sarcopenia was defined by the total muscle area at the level of the third lumbar vertebra measured on computed tomography.

There were 16 patients (11%) with CF and 80 patients (56%) with sarcopenia. CF was associated with high age (p < 0.0001), severe postoperative complications (Clavien-Dindo classification ≥3) (p = 0.0059), and postoperative in-hospital stay (p = 0.0013). On the other hand, sarcopenia was not associated with postoperative outcome. Logistic regression analysis revealed that only CF was an independent predictor of severe postoperative complication (risk ratio of 4.2; p = 0.017). The occurrence of organ/space surgical site infection was significantly higher in the frailty group than in the non-frailty group.

CF, but not sarcopenia, is a robust predictor of severe postoperative complications for patients undergoing hepatectomy.