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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. [PMID: 39016206 DOI: 10.1002/jso.27778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Abstract
Frailty has been linked to unfavorable postoperative outcomes in patients with colorectal cancer (CRC). However, the prevalence of frailty among CRC surgery patients and its association with mortality and postoperative complications, as evaluated by the modified frailty index (mFI), have not been thoroughly investigated and necessitate clarification. PubMed, Web of Science, Embase, and CBM databases were systematically searched for relevant studies (up to January 2024), and the pooled prevalence and odds ratio (OR) estimate were calculated. A total of 16 studies containing 245 747 patients undergoing CRC surgery were included. The prevalence of frailty among CRC surgery patients was 31% (95% confidence interval [CI] = 20%-42%; I2 = 100%, p < 0.001). In patients undergoing CRC surgery, frailty was associated with a higher incidence of postoperative complications (OR = 1.94; 95% CI = 1.47-2.56; I2 = 91.9%, p < 0.001), but it did not exhibit any significant correlation with the 30-day mortality (OR = 5.17; 95% CI = 0.39-68.64; I2 = 94.4%, p < 0.001). Frailty is common in CRC surgery and exerts a significant negative impact on the postoperative outcomes. Future research could explore the potential of the mFI to facilitate a more streamlined and precise quantification of frailty, thereby establishing a refined understanding of its correlation with surgery prognosis.
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Affiliation(s)
- Liwen Xia
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Medical College of Soochow University, Suzhou, China
| | - Rulan Yin
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Lifen Mao
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoqing Shi
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, China
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Ramirez CT, Legault NJ, Sketeris KA. Using Mobility Tools within Multidimensional Assessments to Increase Prognostic Awareness and Assist in Shared Decision-Making to Enhance Goal Concordant Care. Semin Oncol Nurs 2024:151675. [PMID: 38902181 DOI: 10.1016/j.soncn.2024.151675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES The purpose of this practice example from one clinical center is to illustrate the use of interdisciplinary mobility, nutrition, and quality-of-life tools to guide prognostication, which can facilitate discussion on further treatment and goals of care. METHODS Peer-reviewed scientific publications, expert opinions, and a case study are used to illustrate the advantages of using interdisciplinary assessment tools to assist in prognostication, culminating in shared decision-making. RESULTS This overview includes tools identified for use by interdisciplinary teams to identify high-risk patients appropriate for timely discussions regarding goals of care to maximize the probability that people receive care aligned with their goals and values that are informed by prognostic concordance. CONCLUSIONS Tools assessing mobility, functional status, nutrition, and quality of life can assist the interdisciplinary team in providing whole-person care and in forecasting mortality, thus giving the team valid and reliable information to present to patients and families in the shared decision-making process. Further research is needed to synthesize findings from these tools and share information amongst team members in a cohesive and reliable manner. IMPLICATIONS FOR NURSING PRACTICE Nurses spend more time at the bedside than any other discipline. Improved knowledge of tools to forecast patients at elevated risk for mortality will empower collaboration with other disciplines to improve prognostic concordance and enhance shared decision-making culminating in optimal patient-centered care.
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Jeon M, Lee SH, Jang JY, Kim S. How can we approach preoperative frailty and related factors in patients with cancer? A scoping review. Nurs Open 2024; 11:e2216. [PMID: 38890786 PMCID: PMC11187855 DOI: 10.1002/nop2.2216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 03/05/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
AIM To identify factors related to preoperative frailty in patients with cancer and map the tools that measure frailty. DESIGN A Scoping review. METHODS This scoping review based on Arksey and O'Malley's framework. Articles from CINAHL, PubMed, EMBASE, and PsycINFO databases published between January 2011 and April 2021. The searched keywords were concepts related to 'cancer', 'frailty' and 'measurement'. RESULTS While 728 records were initially identified, 24 studies were eventually selected. Research on frailty was actively conducted between 2020 and 2021. Factors related to preoperative frailty were age (22.9%), sex (11.4%), body mass index (11.4%) and physical status indicators (54.3%). The most common result of preoperative frailty was postoperative complications (35.0%). 24 instruments were used to measure frailty. IMPLICATIONS FOR PATIENT CARE Selecting an appropriate preoperative frailty screening tool can help improve patient postoperative treatment outcomes. IMPACT There are many instruments for assessing preoperative frailty, each evaluating a multi-dimensional feature. We identified the frailty screening tools used today, organized the factors that affect frailty, and explored the impact of frailty. Identifying and organizing frailty measurement tools will enable appropriate evaluation. REPORTING METHOD PRISMA-ScR. PATIENT CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Misun Jeon
- College of Nursing and Brain Korea 21 FOUR ProjectYonsei UniversitySeoulSouth Korea
| | - Sang Hwa Lee
- College of Nursing and Brain Korea 21 FOUR ProjectYonsei UniversitySeoulSouth Korea
| | - Ji Yoon Jang
- College of Nursing and Brain Korea 21 FOUR ProjectYonsei UniversitySeoulSouth Korea
| | - Sanghee Kim
- College of Nursing & Mo‐Im Kim Nursing Research InstituteYonsei UniversitySeoulSouth Korea
- Department of Artificial Intelligence, College of ComputingYonsei UniversitySeoulSouth Korea
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Ding L, Hua Q, Xu J, Yang J, Yao C. Predictive performance of different measures of frailty (CFS, mFI-11, mFI-5) on postoperative adverse outcomes among colorectal cancer patients: a diagnostic meta-analysis. Eur Geriatr Med 2024; 15:471-479. [PMID: 38488983 DOI: 10.1007/s41999-024-00960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/07/2023] [Indexed: 03/17/2024]
Abstract
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.
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Affiliation(s)
- Lingyu Ding
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qianwen Hua
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jiaojiao Xu
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jing Yang
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Cui Yao
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Ahuja V, Gibson C, Machado N, King JT. Impact of frailty on complications and length of stay after minimally invasive adrenalectomy surgery. Surgery 2024; 175:336-341. [PMID: 38049363 DOI: 10.1016/j.surg.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/05/2023] [Accepted: 10/24/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Adrenal disease requiring surgery incidence increases with age, and minimally invasive adrenalectomy procedures have improved the safety of adrenal surgery. This study evaluates the perioperative outcomes of elective adrenalectomies when performed in older patients and how frailty affects such outcomes. METHODS Patients undergoing elective minimally invasive adrenalectomy were identified using the American College of Surgeon's National Surgical Quality Improvement Program Participant Use Targeted File years 2005 to 2020. The surgical indication was categorized as a benign disease, an endocrine disorder, or a malignant disease. Frailty was defined using the 5-item modified frailty index. Multivariable regressions were used to model the relationship of age and frailty with surgical outcomes. RESULTS In 8,693 minimally invasive adrenalectomy patients, 5,281 (61%) were female, 5,026 (58%) were White, and 1,924 (22%) were aged 65 years or older. Surgical indications were benign disease 5,487 (63%), endocrinopathy 2,850 (33%), and malignancy 356 (4%). Patients aged <65 years (compared to those aged ≥65) were more likely to have a 5-item modified frailty index = 0 (26% vs 14%, respectively) and less likely to have a 5-item modified frailty index = ≥3 (2% vs 4%, respectively; P < .001). OUTCOMES 30-day mortality 20 (0.2%), complications 459 (5%), return to operating room 73 (0.8%), and median length of stay 2 days. Thirty-day mortality was associated with a 5-item modified frailty index ≥3 (P = .009) and endocrine disease (P = .005) but not with age. Complications were associated with a 5-item modified frailty index ≥2 (≤P < .001) and malignant disease (P = .002), but not with age. CONCLUSION Minimally invasive adrenalectomy has low 30-day mortality and complication rates that increase with frailty and not age. Frailty is a better predictor than the age of most adverse outcomes after elective minimally invasive adrenalectomy.
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Affiliation(s)
- Vanita Ahuja
- Department of Surgery, Yale University School of Medicine, New Haven, CT; Surgical Service, VA Connecticut Healthcare System, West Haven, CT.
| | - Courtney Gibson
- Department of Surgery, Yale University School of Medicine, New Haven, CT; Surgical Service, VA Connecticut Healthcare System, West Haven, CT
| | - Nikita Machado
- Department of Surgery, Yale University School of Medicine, New Haven, CT; Surgical Service, VA Connecticut Healthcare System, West Haven, CT
| | - Joseph T King
- Surgical Service, VA Connecticut Healthcare System, West Haven, CT; Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
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Roohollahi F, Molavi S, Mohammadi M, Mohamadi M, Mohammadi A, Kankam SB, Farahbakhsh F, Moarrefdezfouli A, Peters ME, Albrecht JS, Gardner RC, Rahimi-Movaghar V. Prognostic Value of Frailty for Outcome Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J Neurotrauma 2024; 41:331-348. [PMID: 37416987 DOI: 10.1089/neu.2023.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Frailty is a known predictor of negative health outcomes. The role of frailty in predicting outcomes after traumatic brain injury (TBI), however, is unclear. This systematic review aimed to evaluate the association between frailty and adverse outcomes in patients with TBI. We identified relevant articles that investigated the relationship between frailty and outcomes in patients with TBI by searching PubMed/MEDLINE, Web of Science, Scopus, and EMBASE from inception until 23 March 2023. To evaluate the risk of bias in the included studies, we utilized the Newcastle-Ottawa Scale (NOS). In addition, quantitative synthesis and meta-analyses were performed. We identified 12 studies that met our inclusion criteria; three were prospective. Of included studies, eight had low risk, three had moderate risk, and one had high risk of bias. Frailty was significantly associated with death in five studies, with an increased risk of in-hospital death and complications observed in frail patients. Frailty was associated with longer hospital stays and unfavorable outcome measured by the Extended Glasgow Outcome Scale (GOSE) in four studies. The meta-analysis found that higher frailty significantly increased the odds of non-routine discharge and unfavorable outcome as measured by GOSE scores of 4 or lower. The pooled odds ratio (OR) for non-routine discharge, was 1.80, with a 95% confidence interval (CI) of 1.15-2.84; and for unfavorable outcome, it was 1.91, with a 95% CI of 1.09-3.36. The analysis, however, did not find a significant predictive role for frailty on death (30-day or in-hospital death). The OR for higher frailty and death was 1.42 with a 95% CI of 0.92-2.19. Frailty should be considered in the evaluation of patients with TBI to identify those who may be at increased risk of negative outcomes.
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Affiliation(s)
- Faramarz Roohollahi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Spine Center of Excellence , Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shervin Molavi
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mobin Mohamadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samuel Berchi Kankam
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Spine Center of Excellence , Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Farahbakhsh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Moarrefdezfouli
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Raquel C Gardner
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Metoyer GT, Ali Asgar J, D'Adamo CR, Wolf JH, Katlic M, Svoboda S, Mavanur A. The modified frailty index predicts postoperative venous thromboembolism incidence better than older age in colorectal surgery patients. Am J Surg 2023:S0002-9610(23)00440-3. [PMID: 37802702 DOI: 10.1016/j.amjsurg.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Garyn T Metoyer
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA.
| | - Juzer Ali Asgar
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA; University of Medicine and Health Sciences, 275 7th Ave 26th Floor, New York, NY, 10001, USA.
| | - Christopher R D'Adamo
- Department of Family and Community Medicine, University of Maryland School of Medicine, Center for Integrative Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA.
| | - Joshua H Wolf
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA; Department of Surgery, George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA.
| | - Mark Katlic
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA; Department of Surgery, George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC, 20037, USA.
| | - Shane Svoboda
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA.
| | - Arun Mavanur
- Department of Surgery, Sinai Hospital, 2401 W Belvedere Ave, Baltimore, MD, 21215, USA; Department of Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA.
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8
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Strang P, Schultz T. The Impact of Frailty on Palliative Care Receipt, Emergency Room Visits and Hospital Deaths in Cancer Patients: A Registry-Based Study. Curr Oncol 2023; 30:6623-6633. [PMID: 37504346 PMCID: PMC10378432 DOI: 10.3390/curroncol30070486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on end-of-life healthcare utilization in deceased cancer patients. METHOD Hospital Frailty Risk Scores (HFRS) were calculated based on 109 weighted International Classification of Diseases 10th revision (ICD-10) diagnoses, and HFRS was related to (a) receipt of specialized palliative care, (b) unplanned emergency room (ER) visits during the last month of life, and (c) acute hospital deaths. RESULTS A total of 20,431 deceased cancer patients in ordinary accommodations were studied (nursing home residents were excluded). Frailty, as defined by the HFRS, was more common in men than in women (42% vs. 38%, p < 0.001) and in people residing in less affluent residential areas (42% vs. 39%, p < 0.001). Patients with frailty were older (74.1 years vs. 70.4 years, p < 0.001). They received specialized palliative care (SPC) less often (76% vs. 81%, p < 0.001) but had more unplanned ER visits (50% vs. 35%, p < 0.001), and died more often in acute hospital settings (22% vs. 15%, p < 0.001). In multiple logistic regression models, the odds ratio (OR) was higher for frail people concerning ER visits (OR 1.81 (1.71-1.92), p < 0.001) and hospital deaths (OR 1.66 (1.51-1.81), p < 0.001), also in adjusted models, when controlled for age, sex, socioeconomic status at the area level, and for receipt of SPC. CONCLUSION Frailty, as measured by the HFRS, significantly affects end-of-life cancer patients and should be considered in oncologic decision-making.
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Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholms Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
- Research and Development Department, Stockholm's Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
| | - Torbjörn Schultz
- Research and Development Department, Stockholm's Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
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McGovern J, Grayston A, Coates D, Leadbitter S, Hounat A, Horgan PG, Dolan RD, McMillan DC. 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; 23:9. [PMID: 36609242 PMCID: PMC9817261 DOI: 10.1186/s12877-022-03703-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While the current literature suggests an association with frailty and clinical outcomes in patients undergoing surgery for colorectal cancer (CRC), the basis of this relationship is unclear. AIM Examine the relationship between frailty, malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer. METHODS Consecutive patients who underwent potentially curative resection for colorectal cancer, between April 2008 and April 2018, were identified from a prospectively maintained database. Frailty was defined using the modified five-item frailty index (mFI-5). Body composition measures included CT-derived skeletal muscle index (SMI) and density (SMD). Systemic inflammatory status was determined using Systemic Inflammatory Grade (SIG). Outcomes of interest were the incidence of post-operative complications and thirty-day mortality. Associations between categorical variables were examined using χ2 test and binary logistics regression analysis. RESULTS 1002 patients met the inclusion criteria. 28% (n = 221) scored 2 or more on the mFI-5. 39% (n = 388) of patients had a post-operative complication (Clavien-Dindo I-IV) and 1% (n = 11) died within thirty days of surgery. On univariate analysis, mFI-5 frailty score, was significantly associated with advanced age (p < 0.001), colonic tumours (p < 0.001), reduced use of neo-adjuvant chemotherapy (p < 0.05), higher BMI (p < 0.05), low SMD (p < 0.001), elevated NLR (p < 0.05), elevated mGPS (p < 0.05), elevated SIG (p < 0.05), incidence of post-operative complications (p < 0.001) and thirty-day mortality (p < 0.05). On multivariate analysis, male sex (p < 0.05), elevated SIG (p < 0.05) and mFI-5 score (p < 0.01) remained significantly associated with the incidence of post-operative complications. mFI-5 frailty was found to remain significantly associated with the incidence post-operative complications in patients who were SIG 0 (p < 0.05). CONCLUSION mFI-5 frailty score was found to be significantly associated with age, systemic inflammation and post-operative outcomes in patients undergoing potentially curative resections for CRC. Incorporation of an assessment of systemic inflammatory status in future frailty screening tools may improve their prognostic value.
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Affiliation(s)
- Josh McGovern
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Alexander Grayston
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Dominic Coates
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Stephen Leadbitter
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Adam Hounat
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Paul G. Horgan
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Ross D. Dolan
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
| | - Donald C McMillan
- grid.8756.c0000 0001 2193 314XAcademic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building, G31 2ER Glasgow, UK
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10
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Chen SY, Wang TY, Zhao C, Wang HJ. Oxidative stress bridges the gut microbiota and the occurrence of frailty syndrome. World J Gastroenterol 2022; 28:5547-5556. [PMID: 36304085 PMCID: PMC9594011 DOI: 10.3748/wjg.v28.i38.5547] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/31/2022] [Accepted: 09/23/2022] [Indexed: 02/06/2023] Open
Abstract
The incidence of frailty gradually increases with age. This condition places a heavy burden on modern society, of which the aging population is increasing. Frailty is one of the most complicated clinical syndromes; thus, it is difficult to uncover its underlying mechanisms. Oxidative stress (OS) is involved in frailty in multiple ways. The association between the gut microbiota (GM) and frailty was recently reported. Herein, we propose that OS is involved in the association between the GM and the occurrence of frailty syndrome. An imbalance between oxidation and antioxidants can eventually lead to frailty, and the GM probably participates in this process through the production of reactive oxygen species. On the other hand, OS can disturb the GM. Such dysbiosis consequently induces or exacerbates tissue damage, leading to the occurrence of frailty syndrome. Finally, we discuss the possibility of improving frailty by intervening in the vicious cycle between the imbalance of OS and dysbiosis.
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Affiliation(s)
- Si-Yue Chen
- Laboratory of Neuropsychopharmacology, College of Fundamental Medicine, Shanghai University of Medicine & Health Science, Shanghai 201318, China
| | - Tong-Yao Wang
- Key Laboratory of Medical Molecular Virology, School of Basic Medical Sciences, Shanghai Medical College & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Chao Zhao
- Key Laboratory of Medical Molecular Virology, School of Basic Medical Sciences, Shanghai Medical College & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Frontiers Science Center, Shanghai 200032, China
| | - Hui-Jing Wang
- Laboratory of Neuropsychopharmacology, College of Fundamental Medicine, Shanghai University of Medicine & Health Science, Shanghai 201318, China
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11
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The survival gap between young and older patients after surgical resection for colorectal cancer remains largely based on early mortality: A EURECCA comparison of four European countries. J Geriatr Oncol 2022; 13:803-812. [DOI: 10.1016/j.jgo.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/21/2022] [Accepted: 04/15/2022] [Indexed: 11/18/2022]
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12
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McGovern J, Dolan RD, Horgan PG, Laird BJ, McMillan DC. The prevalence and prognostic value of frailty screening measures in patients undergoing surgery for colorectal cancer: observations from a systematic review. BMC Geriatr 2022; 22:260. [PMID: 35351011 PMCID: PMC8962494 DOI: 10.1186/s12877-022-02928-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/11/2022] [Indexed: 02/08/2023] Open
Abstract
Introduction Frailty is a complex multifactorial syndrome characterised by a significant increase in vulnerability and worsened health outcomes. Despite a range of proposed frailty screening measures, the prevalence and prognostic value of frailty in patients undergoing surgery for colorectal cancer is not clear. Aim The aim of this present review was to examine the use of commonly employed frailty screening measures in patients undergoing surgery for colorectal cancer. Methods A systematic search of PubMed and Medline was carried out to identify studies reporting the use of frailty screening tools or measures in patients undergoing surgery for colorectal cancer. The screening measure used and prevalence of frailty within the population were recorded. Outcomes of interest were the incidence of post-operative complications, 30-day mortality and overall survival. Results Of the 15 studies included (n = 97, 898 patients), 9 studies were retrospective and included patients aged 70 years or older (n = 96, 120 patients). 5 of 12 studies reported that frailty was independently associated with the incidence of post-operative complications. There was also evidence that frailty was independently associated with 30-day mortality (1 of 4 studies, n = 9, 252 patients) and long-term survival (2 of 3 studies, n = 1, 420 patients). Conclusions Frailty was common in patients with colorectal cancer and the assessment of frailty may have prognostic value in patients undergoing surgery. However, the basis of the relationship between frailty and post-operative outcomes is not clear and merits further study.
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Affiliation(s)
- Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Barry J Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
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Computed Tomography Assessment of Sarcopenic Myosteatosis for Predicting Overall Survival in Colorectal Carcinoma: Systematic Review. J Comput Assist Tomogr 2022; 46:157-162. [PMID: 35297571 DOI: 10.1097/rct.0000000000001281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND As the US population ages, cancer incidence and prevalence are projected to increase. In the last decade, there has been an increased interest in the opportunistic use of computed tomography (CT) scan data to predict cancer prognosis and inform treatment based on body composition measures, especially muscle measures for sarcopenia. OBJECTIVE This article aimed to perform a systematic review of current literature related to CT assessment of muscle attenuation values for myosteatosis in colorectal cancer (CRC) survival prediction. RESULTS Initial broad search of CT and CRC yielded 4234 results. A more focused search strategy narrowed this to 129 research papers, and 13 articles met the final inclusion criteria. Twelve of 13 studies found a statistically significant decrease in overall survival according to Hounsfield unit (HU)-based sarcopenia, with hazard ratios ranging from 1.36 to 2.94 (mean, 1.78). However, the specific criteria used to define myosteatosis by CT varied widely, with attenuation thresholds ranging from 22.5 to 47.3 HU, often further subdivided by sex and/or body mass index. CONCLUSIONS Current evidence suggests that a strong association between CT-based muscle attenuation values for myosteatosis assessment correlates with overall survival in CRC. However, more research is needed to verify these findings and determine appropriate threshold values for more diverse patient populations. Because CRC patients are staged and followed by CT, the opportunity exists for routine objective myosteatosis assessment in the clinical setting.
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14
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Gu C, Lu A, Lei C, Wu Q, Zhang X, Wei M, Wang Z. Frailty index is useful for predicting postoperative morbidity in older patients undergoing gastrointestinal surgery: a prospective cohort study. BMC Surg 2022; 22:57. [PMID: 35172806 PMCID: PMC8851713 DOI: 10.1186/s12893-022-01471-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 01/05/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Many assessment tools have been used to identify frail surgical patients. This study was designed to explore the prediction value of the frailty index (FI) for postoperative morbidity in older patients undergoing elective gastrointestinal surgery. METHODS Between January 2019 and September 2020, we conducted a prospective study in our hospital, and patients aged over 65 years were enrolled. The FI assessment was conducted by two specialist nurses based on the 38-item scale, and patients were considered frail if the FI score was ≥ 0.25. The primary outcome was 30-day postoperative morbidity. Univariable and multivariable analyses were used to find the risk factors related to postoperative morbidity. RESULTS A total of 246 consecutive patients were enrolled, for whom the median age was 72.0 [interquartile range (IQR): 67.0-77.0] years old, and 175 (71.1%) were male. Of these, 47 (19.1%) were frail. Patients with frailty were associated with older age (p < 0.001), higher American Society of Anesthesiologists (ASA) grade (p = 0.006), lower body mass index (p = 0.001), lower albumin (p = 0.003) and haemoglobin (p < 0.001) levels, increased blood loss (p = 0.034), increased risk of postoperative morbidity (p < 0.001), increased median length of stay (p = 0.017), and increased median postoperative hospital stay (p = 0.003). Multivariable analysis revealed that ASA grade [odds ratio (OR): 2.59, 95% confidence interval (CI) 1.19-5.64, p = 0.016], FI score (OR 7.68, 95% CI 3.19-18.48, p < 0.001) and surgical complexity (OR 22.83, 95% CI 5.46-95.51, p < 0.001) were independent predictors of 30-day postoperative morbidity. However, for patients with major surgery, FI score was the only independent predictor (OR 8.67, 95% CI 3.23-23.25, p < 0.001). CONCLUSION Frailty was associated with adverse perioperative outcomes, and the 38-item FI scale was a useful frailty screening tool for older patients undergoing elective gastrointestinal surgery. For patients with major surgery, frailty was a more reliable predictor of postoperative 30-day morbidity than age and ASA grade.
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Affiliation(s)
- Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Anqing Lu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Chen Lei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China.
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15
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Shaw JF, Budiansky D, Sharif F, McIsaac DI. The Association of Frailty with Outcomes after Cancer Surgery: A Systematic Review and Metaanalysis. Ann Surg Oncol 2022; 29:4690-4704. [DOI: 10.1245/s10434-021-11321-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/21/2021] [Indexed: 12/24/2022]
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16
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Iwasaki M, Ishikawa M, Namizato D, Sakamoto A. A worse ECOG-PS is associated with 30-day mortality among patients over 90 years old in non-cardiac surgeries: A single-center retrospective study. J NIPPON MED SCH 2021; 89:295-300. [PMID: 34840213 DOI: 10.1272/jnms.jnms.2022_89-304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A growing number of older patients are undergoing surgeries. The reliable pre-operative predictive factors of surgical mortality among older patients remained unclear. This study compared the predictive factors for 30-day survival in patients over 90 years old after their non-cardiac surgery. METHODS A retrospective study at Nippon Medical School hospital was performed for patients aged >90 years who underwent non-cardiac surgeries between 2010 and 2020. Measurements included age, gender, American Society of Anesthesiologists physical status (ASA-PS), pre-operative Charlson score, pre-operative fall risk assessment, Eastern Cooperative Oncology Group performance status (ECOG-PS), the modified 5-item frailty index (mFI-5), the presence of intra-operative transfusion, post-operative complications, and 30-day survival post-surgery. RESULTS A total of 327 cases of elective surgery and 149 cases of emergency surgery were examined. The non-survival group (n=20, 4.2%) had significantly worse pre-operative ASA-PS in emergency cases (non-survival vs. survivor group, 2.8 [2-3] vs. 2.3 [1-4], p=0.045), ECOG-PS (3.0 [2-4] vs. 1.0 [0-4], p<0.001), and mFI-5 values (3.0 [1-4] vs. 1.0 [0-3], p<0.001), more emergency cases (75.0% vs. 36.2%, p=0.004), and a greater need for intra-operative transfusion (55.0% vs. 13.4%, p<0.001). Among the frailty assessment methods, ECOG-PS was the most efficient for 30-day mortality (area under curve, ECOG-PS: 0.98, p<0.001; mFI-5: 0.86, p<0.001; Charlson score: 0.53, p=0.71; fall risk assessment: 0.55, p=0.44). Kaplan-Maier curves and a multivariate logistic regression analysis demonstrated that ECOG-PS>3 was significantly associated with 30-day mortality (ECOG-PS: Kaplan-Maier curve, p<0.001, Log-rank test; odds ratio 1.71, 95%CI: 1.35-2.16, p<0.001). CONCLUSIONS After non-cardiac surgery in patients >90 years old, ECOG-PS>3 was significantly correlated with 30-day mortality.
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Affiliation(s)
- Masae Iwasaki
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
| | - Masashi Ishikawa
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
| | - Dai Namizato
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
| | - Atsuhiro Sakamoto
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
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17
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Hassab T, McKinney D, D'Adamo CD, Svoboda S, Katlic M, Wolf JH. Short-Term Outcomes for Restorative and Non-Restorative Proctocolectomy in Older Adults. J Surg Res 2021; 269:11-17. [PMID: 34500178 DOI: 10.1016/j.jss.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Curative surgery for ulcerative colitis can be subdivided into restorative (with pouch and anastomosis) and non-restorative operations. Restorative surgery in older adults is controversial, due to concerns about surgical risk and long-term functional outcome. The goal of this study is to compare 30-day outcomes for restorative and non-restorative surgery in older adults with ulcerative colitis. METHODS Data were obtained from the American College of Surgeons National Surgical Quality Initiative Program from 2012-2018. Patients were included if they were >65 years old and had ulcerative colitis. Restorative and non-restorative surgeries were defined with procedure codes. Patient characteristics and adverse surgical outcomes were compared between restorative and non-restorative surgeries utilizing chi-square tests and Fisher's exact tests. Multivariate logistic regression models were constructed to evaluate the association of restorative versus non-restorative surgery with adverse surgical outcomes while adjusting for potential confounders. RESULTS Of 392 total patients, 95 had restorative and 297 had non-restorative surgery. Patients undergoing restorative surgery, compared to non-restorative surgery, were significantly younger (P<0.01), had lower incidences of steroid usage (P<0.001) and higher rates of readmission (P = 0.02). There were no differences in post-operative complications between the groups in both unadjusted analyses and covariate-adjusted regression analysis (P > 0.05). CONCLUSION In carefully selected older patients with ulcerative colitis, restorative surgery is associated with increased readmission, but otherwise similar rates of morbidity or mortality compared to non-restorative surgery. Data regarding postoperative functional outcome and quality of life are also needed to help select the most appropriate curative option for older adults.
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Affiliation(s)
- Tarek Hassab
- Sinai Hospital of Baltimore, Department of Surgery, Baltimore, Maryland.
| | - Duncan McKinney
- Sinai Hospital of Baltimore, Department of Surgery, Baltimore, Maryland; Trinity Medical Sciences University, School of Medicine
| | - Christopher D D'Adamo
- Sinai Hospital of Baltimore, Department of Surgery, Baltimore, Maryland; University of Maryland School of Medicine, Department of Family and Community Medicine,Baltimore, Maryland
| | - Shane Svoboda
- Sinai Hospital of Baltimore, Department of Surgery, Baltimore, Maryland; George Washington University, Department of Surgery, Washington, District of Columbia
| | - Mark Katlic
- Sinai Hospital of Baltimore, Department of Surgery, Baltimore, Maryland; George Washington University, Department of Surgery, Washington, District of Columbia
| | - Joshua H Wolf
- Sinai Hospital of Baltimore, Department of Surgery, Baltimore, Maryland; George Washington University, Department of Surgery, Washington, District of Columbia
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Goshtasbi K, Abiri A, Lehrich BM, Abouzari M, Lin HW, Djalilian HR, Hsu FPK, Kuan EC. Association between modified frailty index and surgical outcomes in intradural skull base surgery. J Clin Neurosci 2021; 91:255-259. [PMID: 34373037 DOI: 10.1016/j.jocn.2021.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/22/2021] [Accepted: 07/18/2021] [Indexed: 12/21/2022]
Abstract
The objective of this study is to evaluate the impact of preoperative frailty on short-term outcomes following intradural resection of skull base lesions. The 2005-2017 ACS-NSQIP database was queried for 30-day post-operative outcomes of patients undergoing intradural resection of the skull base, extracted by CPT codes 61601, 61606, 61608, and 61616. Five-item modified frailty index (mFI) was calculated based on the history of diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, chronic hypertension, and functional status. A total of 701 patients (58.8% female, 72.0% white) were included with a mean age of 51.8 ± 14.7 years. Compared to patients with mFI = 0 (n = 403), patients with mFI ≥ 1 (n = 298) were more likely to have higher rates of reoperation (13.4% vs. 8.7%, p = 0.045), medical complications (20.5% vs. 9.2%, p < 0.001), surgical complications (13.8% vs. 8.4%, p = 0.024), discharge to non-home facility (DNHF) (24.8% vs. 13.3%, p < 0.001), and prolonged length of hospitalization (7.3 ± 6.8 days vs. 5.6 ± 5.0, p = 0.003). Moreover, mFI = 1-3 was also associated with higher BMI, non-white race, high ASA, and older age (all p < 0.05). Upon adjusting for age, BMI, race, ASA score, and surgical site, multivariate regression analysis demonstrated that higher mFI (treated as a continuous variable) was associated with higher odds of medical complications (OR = 1.630, CI = 1.153-2.308, p = 0.006), surgical complications (OR = 1.594, CI = 1.042-2.438, p < 0.031), and LOS ≥ 10 days (OR = 1.609, CI = 1.176-2.208, p = 0.003). In conclusion, the 5-item mFI can be an independent predictor of several important short-term surgical outcomes following intradural resection of skull base lesions, warranting further investigations into its clinical utility.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA; Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA.
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19
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Ding L, Lu J, Zhu H, Zhu S, Xu X, Hua H, Chen L, Zhao K, Xu Q. Effects of preoperative frailty on outcomes following surgery among patients with digestive system tumors: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:3040-3048. [PMID: 34325940 DOI: 10.1016/j.ejso.2021.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/05/2021] [Accepted: 07/21/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Frailty is common in patients who undergo digestive system tumor surgery. This review aimed to explore the effects of preoperative frailty on multiple outcomes following surgery among patients with digestive system tumors. METHODS PubMed (Medline), Embase, Web of Science, and other databases were searched from the inception of each database to April 2021. Meta-analysis or qualitative synthesis was performed to examine the relationship between preoperative frailty and adverse postoperative outcomes. RESULTS A total of 29 studies encompassing 122,548 patients were included. Through meta-analysis, frailty was associated with an increased risk of total complications (risk ratio [RR] 1.44; 95 % confidence interval [CI] 1.39 to 1.50), major complications (RR 1.72; 95 % CI 1.51 to 1.95), 30-d mortality (RR 2.40; 95 % CI 2.14 to 2.70), and 5-year mortality (RR 1.74; 95 % CI 1.35 to 2.24). Through qualitative synthesis, compared with non-frail patients, two studies found that frail patients had a worse quality of life, and three studies reported that frail patients experienced greater rates of non-home discharge. However, two studies demonstrated inconsistent conclusions regarding the relationship between frailty and functional status. CONCLUSIONS Preoperative frailty was an important risk factor for multiple adverse postoperative outcomes of patients with digestive system tumors, including objective clinical outcomes and patient-centered outcomes. Future studies focusing on the effects of frailty on patient-centered outcomes such as quality of life and functional status are needed.
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Affiliation(s)
- Lingyu Ding
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Jinling Lu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China.
| | - Xinyi Xu
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Hongxia Hua
- Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Li Chen
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China.
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20
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Podda M, Sylla P, Baiocchi G, Adamina M, Agnoletti V, Agresta F, Ansaloni L, Arezzo A, Avenia N, Biffl W, Biondi A, Bui S, Campanile FC, Carcoforo P, Commisso C, Crucitti A, De'Angelis N, De'Angelis GL, De Filippo M, De Simone B, Di Saverio S, Ercolani G, Fraga GP, Gabrielli F, Gaiani F, Guerrieri M, Guttadauro A, Kluger Y, Leppaniemi AK, Loffredo A, Meschi T, Moore EE, Ortenzi M, Pata F, Parini D, Pisanu A, Poggioli G, Polistena A, Puzziello A, Rondelli F, Sartelli M, Smart N, Sugrue ME, Tejedor P, Vacante M, Coccolini F, Davies J, Catena F. Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project. World J Emerg Surg 2021; 16:35. [PMID: 34215310 PMCID: PMC8254305 DOI: 10.1186/s13017-021-00378-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts' consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. METHODS The discussion among the steering group of clinical experts and methodologists from the societies' expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020-January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. CONCLUSIONS The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.
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Affiliation(s)
- Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy.
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Gianluca Baiocchi
- ASST Cremona, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Michel Adamina
- Department of Colorectal Surgery, Cantonal Hospital of Winterthur, Winterthur - University of Basel, Basel, Switzerland
| | | | - Ferdinando Agresta
- Department of General Surgery, Vittorio Veneto Hospital, AULSS2 Trevigiana del Veneto, Vittorio Veneto, Italy
| | - Luca Ansaloni
- 1st General Surgery Unit, University of Pavia, Pavia, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Nicola Avenia
- SC Chirurgia Generale e Specialità Chirurgiche Azienda Ospedaliera Santa Maria, Università degli Studi di Perugia, Terni, Italy
| | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Antonio Biondi
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy
| | - Simona Bui
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Fabio C Campanile
- Department of Surgery, ASL VT - Ospedale "San Giovanni Decollato - Andosilla", Civita Castellana, Italy
| | - Paolo Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Claudia Commisso
- Department of Radiology, University Hospital of Parma, Parma, Italy
| | - Antonio Crucitti
- General and Minimally Invasive Surgery Unit, Cristo Re Hospital and Catholic University, Rome, Italy
| | - Nicola De'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, Regional General Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Gian Luigi De'Angelis
- Department of Medicine and Surgery, Gastroenterology and Endoscopy Unit, University of Parma, Parma, Italy
| | | | - Belinda De Simone
- Department of General and Metabolic Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | | | - Giorgio Ercolani
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | - Federica Gaiani
- Department of Medicine and Surgery, Gastroenterology and Endoscopy Unit, University of Parma, Parma, Italy
| | | | | | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ari K Leppaniemi
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Andrea Loffredo
- UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, USA
| | | | | | - Dario Parini
- Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Adolfo Pisanu
- Department of Emergency Surgery, Cagliari University Hospital "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Polistena
- Dipartimento di Chirurgia Pietro Valdoni Policlinico Umberto I, Sapienza Università degli Studi di Roma, Rome, Italy
| | - Alessandro Puzziello
- UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy
| | - Fabio Rondelli
- SC Chirurgia Generale e Specialità Chirurgiche Azienda Ospedaliera Santa Maria, Università degli Studi di Perugia, Terni, Italy
| | | | | | - Michael E Sugrue
- Letterkenny University Hospital and CPM sEUBP Interreg Project, Letterkenny, Ireland
| | | | - Marco Vacante
- Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
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21
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Frailty is a stronger predictor than age for postoperative morbidity in Crohn's disease. Surgery 2021; 170:1061-1065. [PMID: 34059345 DOI: 10.1016/j.surg.2021.04.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/11/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with Crohn's disease are particularly susceptible to preoperative frailty owing to the chronic nature of the illness and immunosuppressive therapy. The hypothesis in this study was that frailty would have a greater impact on postoperative outcome than age in older individuals with Crohn's disease. METHODS Data were obtained from the National Surgical Quality Improvement Program from the years 2012 to 2018. Patients with Crohn's disease who underwent a bowel resection were identified from diagnostic and procedure codes. Frailty was assessed using the 5-point Simplified Frailty Index (0-not frail, 5-most frail). Age was defined as an ordinal variable with 3 age ranges (18-64, 65-79, >80 years). Aggregate morbidity was classified according to the standard National Surgical Quality Improvement Program definitions. Simplified Frailty Index was evaluated as a potential predictor of morbidity and mortality using covariate-adjusted logistic regression modeling. RESULTS A total of 9,023 patients underwent bowel resection for Crohn's disease during the study period. Patient Simplified Frailty Index ranged from 0 to 3 (Simplified Frailty Index = 0, 82%; 1, 15%; 2, 2.5%; 3, 0.1%), and higher Simplified Frailty Index was associated with increased age (P < .01). In multivariate regression, Simplified Frailty Index was significantly associated with postoperative morbidity (Simplified Frailty Index ≥ 2: odds ratio = 2.59, 95% confidence interval [1.84-3.63], P < .0001). In contrast, age was not found to be a significant predictor of morbidity when adjusted for Simplified Frailty Index and other covariates (P > .05). CONCLUSION Frailty is a stronger predictor than age for morbidity in Crohn's-related bowel resection. Functional assessments and vulnerability screening should be used to determine surgical candidacy rather than age alone.
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22
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Puts M, Soo WK, Szumacher E, Decoster L. Methods for frailty screening and geriatric assessment in older adults with cancer. Curr Opin Support Palliat Care 2021; 15:16-22. [PMID: 33507036 DOI: 10.1097/spc.0000000000000533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW This review highlights the latest development in the use of geriatric assessment(GA) and frailty assessment for older adults with cancer. RECENT FINDINGS From 2019, there were six large randomized controlled trials (RCTs) completed of GA for older adults with cancer, as well as several studies of frailty screening tools. SUMMARY The findings in this review highlight the benefits of implementing GA, followed by interventions to address the identified issues (GA -guided interventions). Four of six RCTs that implemented GA for older adults with cancer showed positive impact on various outcomes, including treatment toxicity and quality of life. GA implementation varied significantly between studies, from oncologist acting on GA summary, geriatrician comanagement, to full GA by a multidisciplinary team. However, there were several barriers reported to implementing GA for all older adults with cancer, such as access to geriatrics and resource issues. Future research needs to elucidate how to best operationalize GA in various cancer settings. The authors also reviewed frailty screening tools and latest evidence on their use and impact.
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Affiliation(s)
- Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Wee Kheng Soo
- Eastern Health Clinical School, Monash University
- Cancer Services, Eastern Health
- Aged Medicine Program, Eastern Health, Box Hill, Australia
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lore Decoster
- Department of Medical Oncology, Oncologisch Centrum, Universitair ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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