The Modified Frailty Index and Its Association With Esophagectomy Outcomes.

Area of Science:

• Surgical oncology
• Geriatric surgery
• Outcomes research

Background:

• Frailty, characterized by diminished physiological reserve, is linked to adverse surgical outcomes.
• The modified Frailty Index (mFI-5) is a comorbidity-based measure associated with poorer results in some surgical settings.
• The predictive value of mFI-5 for esophagectomy outcomes remains to be fully elucidated.

Purpose of the Study:

• To determine if the modified Frailty Index (mFI-5) can predict major complications or 30-day mortality (M/M) after esophagectomy.
• To assess the association between mFI-5 score and postoperative M/M in patients undergoing esophagectomy.
• To compare the predictive power of the overall mFI-5 score versus its individual components for esophagectomy outcomes.

Main Methods:

• Analysis of the National Surgical Quality Improvement Program targeted database (2016-2022).
• Inclusion of patients undergoing esophagectomy for malignancy.
• Utilized descriptive analysis, univariable, and multivariable logistic regression, with C-statistics to evaluate predictive accuracy for M/M.

Main Results:

• A total of 5657 patients were included in the study.
• The mFI-5 score was significantly associated with M/M in univariate analysis (P<0.0001).
• An mFI-5 score >2 strongly correlated with postoperative M/M (P=0.0002) in multivariable models, with individual comorbidities showing significant predictive value, except for dependent status.

Conclusions:

• Frailty, as measured by mFI-5, is associated with poor outcomes in esophagectomy patients.
• Individual comorbid conditions comprising the mFI-5 are more strongly related to esophagectomy outcomes than the overall frailty score.
• Further research is recommended to explore alternative measures of physiological frailty for improved prediction.