Frailty assessment for risk stratification in pancreatic surgery

Pancreatic cancer usually affects the elderly as 70% of new diagnoses are made in patients older than 65 years. A risk factor for postoperative complications is the accumulation of comorbidities and functional decline, which together define "frailty". The aim of the current study was to assess the impact of frailty on postoperative recovery after pancreatic surgery.

Data of consecutive patients undergoing pancreatic resections between January 2015 and December 2023 were retrospectively analyzed. Postoperative complications were graded according to the Clavien-Dindo Classification (CD), Comprehensive Complication Index (CCI) and complications specific to pancreatic resections as recommended and published by the International Study Group of Pancreatic Surgery. The modified frailty index (mFI) was defined by 11 variables. A mFI score above 0.27 defined frailty according to previous literature.

A pancreatic resection was performed in 190 patients of which 27 (14%) were classified as frail. Male gender was associated with frailty (78%, p = 0.003). Frailty was associated with an increased rate of preoperative biliary drainage. Although intensive care stay was increased in the frail group (median 3 vs. 1 day; p = 0.005), total length of hospital stay was not affected. Frailty was associated with an increased rate of postoperative pancreatic fistula (POPF) grade C (11% vs. 2%, p = 0.038), and a higher comprehensive complication index (26 vs. 12; p = 0.015). Total hospitalization costs were increased for frail patients with 58'022 CHF compared to 44'126 CHF for non-frail patients (p = 0.09).

Assessment of frailty should be implemented for preoperative risk stratification, since frailty is associated with higher morbidity after pancreatic resections.