Frailty index comparison in predicting postoperative outcomes in hepatic cystic echinococcosis: a nested case-control...

Postoperative complications (POC) following hepatic cystic echinococcosis (HCE) surgery remains a challenge. Frailty indices (FIs) as predictors of POC in this context has not been investigated. We aimed to evaluate the predictive value of three frailty assessment tools (mFI-11, FRAIL scale, and PRISMA-7 questionnaire), for POC in patients with HCE undergoing elective surgical treatment.

Nested case-control study in a concurrent cohort. Consecutive patients who underwent elective open surgery for HCE between 2012 and 2020 with a minimum follow-up of 4 years were included. Cases were frail patients with mFI-11 ≥ 0.27, PRISMA-7 ≥ 3, or FRAIL ≥ 3. Cases and controls were matched in a 1:1 based on age, sex, cyst diameter, history of HCE surgery, ultrasonographic characteristics, and cyst location. Primary outcome was overall and severe POC. Sample size was based on overall POC of 28% for cases and 11% for controls, assuming 5% type I error and 80% statistical power. Descriptive and bivariate statistics were applied. Odds ratios (OR) and 95% confidence intervals were calculated, and predictive performance evaluated using area under the receiver operating characteristics curve (AUC), and its comparison applying DeLong test.

70 cases and 70 controls were included. mFI-11 ≥ 0.27 and PRISMA-7 ≥ 3 were identified as prognostic factors for overall and severe POC (p < 0.001 and p = 0.02; and p = 0.02 and p = 0.03, respectively); and FRAIL as an independent factor for overall POC (p = 0.005). Logistic regression adjusting for potential confounding variables confirmed mFI-11 ≥ 0.27 as an independent prognostic factor for overall POC (OR 4.8; p = 0.0001; AUC: 0.762) and severe POC (OR 10.7; p = 0.022; AUC: 0.763).

The mFI-11 index showed the strongest predictive performance for both overall and severe POC in patients underwent HCE.