Comparison of preoperative and postoperative frailty in elderly following gastrointestinal cancer surgery

Abstract

Objectives: This study aimed to compare preoperative and postoperative frailty status in patients undergoing elective gastrointestinal cancer surgery using the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weigh) and Clinical Frailty Scale (CFS) indices and to determine the relationship between frailty and early postoperative complications as well as surgical outcomes.

Methods: This prospective study included patients aged 65 years and older who underwent elective gastrointestinal cancer surgery. Preoperative and early postoperative frailty assessments were conducted using the FRAIL and CFS scores. Statistical analyses were conducted to investigate the association between frailty scores and surgical/clinical outcomes.

Results: Of the 91 patients included in the studythe mean age was 70.9±6.1 years (range: 65-75). The mean FRAIL score increased postoperatively (1.9±1.2 preoperatively to 2.3±1.5 postoperatively, Δpost-pre: 0.4±0.9, P<0.001). A similar trend was observed in the CFS scale, the mean CFS score increased postoperatively (4.8±1.2 preoperatively to 5.1±1.6, postoperatively, Δpost-pre: 0.3±0.8, P<0.001). Patients with higher baseline frailty levels exhibited longer hospital stays (P=0.015), higher mortality rates (P=0.030), and increased rates of discharge with an ostomy or drain (P=0.003).

Conclusions: Our findings suggest that while frailty scores may increase postoperatively, higher baseline frailty score is associated with several adverse outcomes, including prolonged hospital stays, increased mortality, and a higher likelihood of requiring ostomies or drains upon discharge.

Keywords

• Elderly patient
• frailty
• gastrointestinal cancer surgery
• mortality
• FRAIL
• CFS scale

References

1. 1. Patel I, Winer A. Assessing Frailty in Gastrointestinal Cancer: Two Diseases in One? Curr Oncol Rep. 2024;26(1):90-102. doi: 10.1007/s11912-023-01483-5.
2. 2. https://gco.iarc.fr/stories/gastro-intestinal/en Access Date: 15.12.2024.
3. 3. Tang WZ, Tan ZK, Qiu LY, Chen JQ, Jia K. Prevalence and unfavorable outcome of frailty in older adults with gastric cancer: a systematic review and meta-analysis. Support Care Cancer. 2024;32(2):115. doi: 10.1007/s00520-024-08306-8.
4. 4. Barbosa EMS, Pereira AG, Mori V, et al. Comparison between FRAIL Scale and Clinical Frailty Scale in predicting hospitalization in hemodialysis patients. J Nephrol. 2023;36(3):687-693. doi: 10.1007/s40620-022-01532-5.
5. 5. Vermillion SA, Hsu FC, Dorrell RD, Shen P, Clark CJ. Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients. J Surg Oncol. 2017;115(8):997-1003. doi: 10.1002/jso.24617.
6. 6. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489-495. doi: 10.1503/cmaj.050051.
7. 7. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601-608. doi: 10.1007/s12603-012-0084-2
8. 8. Handforth C, Clegg A, Young C, et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol. 2015;26(6):1091-1101. doi: 10.1093/annonc/mdu540.

9. 9. Berger NA, Savvides P, Koroukian SM, et al. Cancer in the elderly. Trans Am Clin Climatol Assoc. 2006;117:147-55; discussion 155-156.
10. 10. McGovern J, Grayston A, Coates D, et al. The relationship between the modified frailty index score (mFI-5), malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer. BMC Geriatr. 2023;23(1):9. doi: 10.1186/s12877-022-03703-2.
11. 11. Xia L, Yin R, Mao L, Shi X. Prevalence and impact of frailty in patients undergoing colorectal cancer surgery: A systematic review and meta-analysis based on modified frailty index. J Surg Oncol. 2024;130(3):604-612. doi: 10.1002/jso.27778.
12. 12. Mullen MM, Porcelli BP, Cripe J, et al. Modified frailty index is predictive of wound complications in obese patients undergoing gynecologic surgery via a midline vertical incision. Gynecol Oncol. 2020;157(1):287-292. doi: 10.1016/j.ygyno.2019.11.008.
13. 13. Wilson JM, Boissonneault AR, Schwartz AM, Staley CA, Schenker ML. Frailty and Malnutrition Are Associated With Inpatient Postoperative Complications and Mortality in Hip Fracture Patients. J Orthop Trauma. 2019;33(3):143-148. doi: 10.1097/BOT.0000000000001386.
14. 14. Panayi AC, Foroutanjazi S, Parikh N, et al. The modified 5-item frailty index is a predictor of perioperative risk in breast reconstruction: An analysis of 40,415 cases. J Plast Reconstr Aesthet Surg. 2022;75(9):2941-2954. doi: 10.1016/j.bjps.2022.04.035.
15. 15. Panayi AC, Knoedler S, Rühl J, et al. A novel surgical risk predictor combining frailty and hypoalbuminemia - a cohort study of 9.8 million patients from the ACS-NSQIP database. Int J Surg. 2024;110(11):6982-6995. doi: 10.1097/JS9.0000000000002025.
16. 16. Tanaka T, Suda K, Inaba K, et al. Impact of Frailty on Postoperative Outcomes for Laparoscopic Gastrectomy in Patients Older than 80 Years. Ann Surg Oncol. 2019;26(12):4016-4026. doi: 10.1245/s10434-019-07640-0.
17. 17. Wang X, Sun Y, Wang P, et al. Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis. Front Oncol. 2022;12:972287. doi: 10.3389/fonc.2022.972287.
18. 18. Garland M, Hsu FC, Shen P, Clark CJ. Optimal Modified Frailty Index Cutoff in Older Gastrointestinal Cancer Patients. Am Surg. 2017;83(8):860-865.
19. 19. Chao YS, McGolrick D, Wu CJ, Wu HC, Chen WC. A proposal for a self-rated frailty index and status for patient-oriented research. BMC Res Notes. 2019;12(1):172. doi: 10.1186/s13104-019-4206-3.
20. 20. Jiang M, Corna L, Amati R, et al. Prevalence and association of frailty with SARS-CoV-2 infection in older adults in Southern Switzerland-Findings from the Corona Immunitas Ticino Study. BMC Geriatr. 2023;23(1):18. doi: 10.1186/s12877-023-03730-7.