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Modified frailty index predicts complications and death after non-bariatric gastrectomies
Konstantinos A Zorbas1, Vic Velanovich2, Nestor F Esnaola3
1Department of Surgery, Bronx Care Health System, New York, NY, USA.
Background:
The modified frailty index (mFI) has been shown to predict mortality and morbidity after major operations. The aim of the present study was to assess the mFI as a preoperative predictor of short-term postoperative complications and 30-day mortality in patients undergoing gastrectomy for non-bariatric diseases.
Methods:
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who underwent total or partial gastrectomy from 2005 to 2011. A mFI was calculated based on 11 variables as previously described. The population divided into the following four categories based on the mFI score: the non-frail (mFI 0), the low frail (mFI 1), the intermediate frail (mFI 2) and frail (mFI ≥3). Thirty-day mortality and postoperative complications were evaluated.
Results:
Overall, 5,711 patients underwent a gastrectomy for non-bariatric diseases. Higher mFI score was associated with higher rates of mortality (from 1.2% in the non-frail group to 10.7% in frail group, P<0.001), overall morbidity (26.7% vs. 51.1%, P<0.001), postoperative Clavien IV complication (6% vs. 24.6%, P<0.001), serious complications (19.3% vs. 42.6%, P<0.001), sepsis-related complications (8.4% vs. 16.4%, P<0.001), cardiopulmonary complications (5% vs. 20.7%, P<0.001) and failure to rescue (5.7% vs. 21.8%, P<0.001).
Conclusions:
Higher mFI score in patients undergoing non-bariatric gastrectomy, is associated with a stepwise greater risk of postoperative morbidity and mortality. MFI Score can be easily calculated preoperatively, from the patient's history, and it can be used as an exceptionally useful criterion for treatment planning.
Insights
The modified frailty index (mFI) effectively predicts higher risks of complications and death after gastrectomy for non-bariatric conditions. This simple preoperative assessment aids in planning patient treatment strategies.
Area of Science:
- Surgical oncology
- Geriatric surgery
- Patient outcomes research
Background:
- The modified frailty index (mFI) is a validated tool for predicting mortality and morbidity post-major surgery.
- Gastrectomy for non-bariatric conditions involves significant risks of complications and mortality.
Purpose of the Study:
- To evaluate the modified frailty index (mFI) as a preoperative predictor of short-term postoperative complications.
- To assess the mFI's ability to predict 30-day mortality in patients undergoing gastrectomy for non-bariatric diseases.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2005-2011).
- Calculated a modified frailty index (mFI) based on 11 variables.
- Categorized patients into four groups: non-frail (mFI 0), low frail (mFI 1), intermediate frail (mFI 2), and frail (mFI ≥3).
Main Results:
- Higher mFI scores correlated with increased rates of 30-day mortality (1.2% to 10.7%).
- Significant associations found between higher mFI and increased overall morbidity (26.7% vs. 51.1%), severe complications (Clavien IV: 6% vs. 24.6%), and failure to rescue (5.7% vs. 21.8%).
- Elevated mFI scores were linked to higher rates of sepsis-related and cardiopulmonary complications.
Conclusions:
- The modified frailty index (mFI) demonstrates a clear, stepwise increase in postoperative morbidity and mortality risk for patients undergoing non-bariatric gastrectomy.
- The mFI is a practical, easily calculable preoperative tool for risk stratification and treatment planning in gastrectomy patients.
