Integration of MSK-FI and clinical variables to predict postoperative complications after esophagectomy

Frailty is associated with adverse clinical outcomes and is recognized as an important predictor of prognosis. Yet, practical frailty-based tools to assess the risk of postoperative complications after radical esophagectomy are still inadequate. The aim of this study was to evaluate the predictive performance of the Memorial Sloan Kettering-Frailty Index (MSK-FI) and to establish a more comprehensive model for forecasting postoperative complications in this patient population.

We retrospectively analyzed 410 patients who underwent radical esophagectomy between 2022 and 2023. Preoperative frailty status of these patients was calculated using MSK-FI. Patients were accordingly classified as frail (MSK-FI ≥2, n=86) or non-frail (MSK-FI <2, n=324). A predictive nomogram was subsequently conducted by incorporating clinical and surgical characteristics.

Compared with the non-frail group, patients in the frail group had significantly higher rates of severe postoperative complications (26.74% vs. 14.20%; P=0.006) and longer hospital stays (11 vs. 10 days, P=0.01). Univariate logistic regression analysis identified age ≥65 years [odds ratio (OR) =2.11, P=0.02], neoadjuvant therapy (OR =1.86, P=0.03), MSK-FI ≥2 (OR =2.21, P=0.008), cervical esophagogastric anastomosis (OR =2.02, P=0.01), and prolonged surgery duration (OR =1.79, P=0.04) as risk factors for severe postoperative complications. These variables were incorporated into multivariable stepwise logistic regression to develop a predictive nomogram model, which demonstrated an area under the curve (AUC) of 0.700 [95% confidence interval (CI): 0.637-0.767].

Preoperative frailty status is associated with an increased risk of adverse perioperative outcomes in patients after radical esophagectomy. The integration of MSK-FI and clinical characteristics in nomogram provides a practical tool for predicting severe postoperative complications.