Predictive Ability of Comorbidity Indices for Surgical Morbidity and Mortality: a Systematic Review and Meta-analysis

Utility of the mFI-5 as a predictor of post-operative outcomes following gastrectomy for gastric cancer: an ACS-NSQIP analysis

BACKGROUND

Gastric cancer is the 5th most common malignancy worldwide. Surgical treatment for the disease can often be highly morbid, especially in elderly patients. The modified 5-item frailty index (mFI-5), a recently developed tool for assessing patient frailty, has been shown to be an effective predictor of post-operative outcomes in various surgical fields. This study aims to assess the utility of the mFI-5 in predicting adverse postoperative outcomes following gastrectomy for gastric cancer.

METHODS

The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent partial or total gastrectomy for gastric cancer between 2011 and 2021. The mFI-5 score was calculated based on the presence of hypertension, congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, and partially or fully dependent functional status. Patients were stratified into 3 groups according to mFI-5 score (mFI-5 = 0, mFI-5 = 1, mFI-5 ≥ 2). Univariate analysis and multivariate logistic regression were used to evaluate the association between mFI-5 score and post-operative outcomes.

RESULTS

7438 patients were identified (mFI-5 = 0: 3032, mFI-5 = 1: 2805, mFI-5 ≥ 2: 1601). mFI-5 ≥ 2 was an independent predictor of overall complications (OR 1.43, p < 0.001), serious complications (OR 1.42, p < 0.001), pneumonia (OR 1.43, p = 0.010), MI (OR 2.91, p = 0.005), and readmission within 30 days (OR 1.33, p = 0.008). Patients with higher frailty were more likely to experience unplanned intubation (OR 2.06, p < 0.001; OR 2.47, p < 0.001), failure to wean from the ventilator (OR 1.68, p = 0.003; OR 2.00, p < 0.001), acute renal failure (OR 3.25, p = 0.003; OR 3.27, p = 0.005), 30-day mortality (OR 1.73, p = 0.009; OR 1.94, p = 0.004), and non-home discharge (OR 1.34, p = 0.001; OR 1.74, p < 0.001) relative to non-frail patients.

CONCLUSION

Higher frailty, as indicated by an increased mFI-5 score, raises the risk of serious post-operative complications in patients with gastric cancer undergoing gastrectomy. The mFI-5 has the potential to help identify high-risk patients and enhance pre-operative discussions and optimization.

Evaluation and Application of Frailty Index in Colorectal Cancer: A Comprehensive Review

Colorectal cancer (CRC) is a common malignant tumor that primarily affects the elderly population. Surgery is one of the main treatment modalities for CRC. Frailty is a prevalent characteristic among the elderly and a leading cause of mortality. The frailty index (FI) is a comprehensive tool for assessing patients' frailty status, quantifying indicators such as weight loss, fatigue, and nutritional status, to reflect the degree of frailty. In recent years, the FI has undergone modifications to more accurately evaluate the risk of surgical complications and prognosis in CRC patients. This review summarizes the methods for frailty assessment, the development and modifications of the FI, and compiles the research findings and applications of the FI in predicting surgical complications, postoperative recovery, and survival rates in CRC patients. Furthermore, limitations in the current modified frailty index (mFI) and future research directions are discussed. This review provides essential references for further understanding the role of frailty in CRC patients and the clinical application of the mFI.

Predictive performance of different measures of frailty (CFS, mFI-11, mFI-5) on postoperative adverse outcomes among colorectal cancer patients: a diagnostic meta-analysis

PURPOSE

To clarify the predictive performance of different measures of frailty, including Clinical Frailty Scale (CFS), 11-factor modified Frailty Index (mFI-11), and 5-factor modified Frailty Index (mFI-5), on adverse outcomes.

METHODS

PubMed, Embase, Web of Science, and other databases were retrieved from the inception of each database to June 2023. The pooled sensitivity, specificity, and the area under the summary receiver operating curve (SROC) values were analyzed to determine the predictive power of CFS, mFI-11, and mFI-5 for adverse outcomes.

RESULTS

A total of 25 studies were included in quantitative synthesis. The pooled sensitivity values of CFS for predicting anastomotic leakage, total complications, and major complications were 0.39, 0.57, 0.45; pooled specificity values were 0.70, 0.58, 0.73; the area under SROC values were 0.58, 0.6, 0.66. The pooled sensitivity values of mFI-11 for predicting total complications and delirium were 0.38 and 0.64; pooled specificity values were 0.83 and 0.72; the area under SROC values were 0.64 and 0.74. The pooled sensitivity values of mFI-5 for predicting total complications, 30-day mortality, and major complications were 0.27, 0.54, 0.25; pooled specificity values were 0.82, 0.84, 0.81; the area under SROC values were 0.63, 0.82, 0.5.

CONCLUSION

The results showed that CFS could predict anastomotic leakage, total complications, and major complications; mFI-11 could predict total complications and delirium; mFI-5 could predict total complications and 30-day mortality. More high-quality research is needed to support the conclusions of this study further.