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Rao SJ, Solsky I, Gunawan A, Shen P, Levine E, Clark CJ. Phase 1 randomized trial of inpatient high-intensity interval training after major surgery. J Gastrointest Surg 2024; 28:528-533. [PMID: 38583906 DOI: 10.1016/j.gassur.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/03/2024] [Accepted: 01/13/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND High-intensity interval training (HIT) can provide physiologic benefits and may improve postoperative recovery but has not been evaluated in inpatients. This study aimed to evaluate the safety and tolerability of HIT after major surgery. METHODS We performed a phase I randomized study comparing HIT with low-intensity continuous ambulation (40 m) during the initial inpatient stay after major surgery at a large academic center. Clinicopathologic and pre- and post-exercise physiologic data were captured. Perceived exertion was measured throughout the intervention. RESULTS Twenty-two subjects were enrolled and randomized with 90% (20 subjects, 10 per arm) completing all aspects of the study. One patient declined participation in the exercise intervention. The HIT and continuous ambulation groups were relatively similar in terms of median age (65.5 vs 63.5), female sex (20% vs 40%), White race (90% vs 90%), having a cancer diagnosis (100% vs 80%), undergoing gastrointestinal surgery (60% vs 80%), median Karnofsky score (60 vs 60), and ability to independently ambulate preoperatively (100% vs 90%). All subjects completed the exercise without protocol deviation, cohort crossover, or safety events. Compared with the continuous ambulation group, the HIT group had higher end median perceived exertion (5.0 [IQR, 5.5] vs 3.0 [IQR, 1.8]), shorter overall time to complete assigned exercise (56.6 seconds vs 91.8 seconds), and a trend toward higher median gait speed over 40 m (0.71 m/s vs 0.44 m/s, P = .126). CONCLUSION HIT in the hospitalized postoperative patient is safe and may be implemented to help promote positive physiologic outcomes and recovery.
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Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States
| | - Ian Solsky
- Atrium Health Wake Forest Baptist, Division of Surgical Oncology, Winston-Salem, North Carolina, United States
| | - Antonius Gunawan
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States
| | - Perry Shen
- Atrium Health Wake Forest Baptist, Division of Surgical Oncology, Winston-Salem, North Carolina, United States
| | - Edward Levine
- Atrium Health Wake Forest Baptist, Division of Surgical Oncology, Winston-Salem, North Carolina, United States
| | - Clancy J Clark
- Atrium Health Wake Forest Baptist, Division of Surgical Oncology, Winston-Salem, North Carolina, United States.
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Osaki T, Tatebe S, Orihara J, Uchinaka E, Ashida K, Hirooka Y, Fujiwara Y. Impact of Frailty and Sarcopenia on Short- and Long-Term Outcomes in Elderly Patients Undergoing Radical Gastrectomy for Gastric Cancer. World J Surg 2023; 47:3250-3261. [PMID: 37777671 DOI: 10.1007/s00268-023-07200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The impact of frailty and sarcopenia in patients with gastric cancer is unclear. This study aimed to comprehensively examine the impact of frailty and sarcopenia on the short- and long-term outcomes in elderly patients undergoing radical gastrectomy for gastric cancer. METHODS We retrospectively assessed 246 patients aged ≥ 65 years who underwent radical gastrectomy. Frailty and sarcopenia were assessed using the modified frailty index (mFI) and psoas muscle mass index (PMI), respectively. RESULTS There were 30 (12.2%) and 60 (24.4%) patients with High-mFI and Low-PMI, respectively. As the age increased, both sexes showed significant correlations with PMI and mFI (r = - 0.238, 0.322, P = 0.003 and 0.002, respectively). High-mFI and Low-PMI did not affect the short-term outcomes. However, High-mFI was an independent risk factor for non-home discharge (P = 0.004) and was a significant predictor of 3- and 5-year overall survival (OS) (HR = 2.76 and 2.26; P = 0.002 and 0.005, respectively) and 1-, 3- and 5-year non-cancer-specific survival (non-CSS) (HR = 4.88, 8.05, and 4.01; P = 0.017, < 0.001, < 0.001, respectively). Low-PMI was a significant predictor of only 5-year OS (HR = 2.03, P = 0.003) and non-CSS (HR = 2.10, P = 0.020). CONCLUSIONS Frailty is significant predictor of non-home discharge and 1-, 3-, 5-year OS and 3- and 5-year non-CSS. Sarcopenia is a significant predictor of 5-year OS and non-CSS. Preoperative assessment of both frailty and sarcopenia can help surgeons to select adequate treatment strategies for the elderly population.
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Affiliation(s)
- Tomohiro Osaki
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan.
| | - Shigeru Tatebe
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Junpei Orihara
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Ei Uchinaka
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Keigo Ashida
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Yasuaki Hirooka
- Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine Graduate, Tottori, Japan
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Czajka S, Taborek M, Krzych ŁJ. Is Frailty a Good Predictor of Postoperative Complications in Elective Abdominal Surgery?-A Single-Center, Prospective, Observational Study. J Pers Med 2023; 13:jpm13050869. [PMID: 37241039 DOI: 10.3390/jpm13050869] [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: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Despite the common occurrence of postoperative complications in patients with frailty syndrome, the nature and severity of this relationship remains unclear. We aimed to assess the association of frailty with possible postoperative complications after elective, abdominal surgery in participants of a single-centre prospective study in relation to other risk classification methods. METHODS Frailty was assessed preoperatively using the Edmonton Frail Scale (EFS), Modified Frailty Index (mFI) and Clinical Frailty Scale (CFS). Perioperative risk was assessed using the American Society of Anesthesiology Physical Status (ASA PS), Operative Severity Score (OSS) and Surgical Mortality Probability Model (S-MPM). RESULTS The frailty scores failed to predict in-hospital complications. The values of AUCs for in-hospital complications ranged between 0.5 and 0.6 and were statistically nonsignificant. The perioperative risk measuring system performance in ROC analysis was satisfactory with AUC ranging from 0.63 for OSS to 0.65 for S-MPM (p < 0.05 for each). CONCLUSIONS The analysed frailty rating scales proved to be poor predictors of postoperative complications in the studied population. Scales assessing perioperative risk performed better. Further studies are needed to obtain optimal predictive tools in senior patients undergoing surgery.
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Affiliation(s)
- Szymon Czajka
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Maria Taborek
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Łukasz J Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
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The impact of the modified frailty index on clinical outcomes for patients with stage IV non-small cell lung cancer receiving chemotherapy. J Geriatr Oncol 2022; 13:654-661. [DOI: 10.1016/j.jgo.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 02/23/2022] [Indexed: 01/20/2023]
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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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Comparison of preoperative assessment tools in older patients undergoing cancer surgery: A prospective study. J Geriatr Oncol 2022; 13:420-425. [PMID: 34998721 DOI: 10.1016/j.jgo.2021.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Surgery in older adults with cancer is complex due to multiple age related confounding factors. There are many scoring systems available for preoperative risk stratifications of older patients. Currently very few prospective studies comparing the various commonly used scales are available. This is the first study which compares the established preoperative risk assessment tools of Eastern Cooperative Oncology Group Performance Scale (ECOG) and American Society of Anaesthesiologists Physical Status Scale (ASA) with frailty scores of Modified Frailty Index (MFI) and Clinical Frailty Scale (CFS). MATERIAL AND METHODS This is a prospective observational study of older patients with cancer who underwent oncosurgery in a tertiary cancer centre during the one-year study period. Patients were scored on the CFS, MFI, ASA and ECOG scales. All patients were followed up for 30 days immediately following surgery and their post operative complications were documented. Univariate and multivariate analyses were done and a p value of ≤0.05 was considered statistically significant. RESULTS Of the 820 patients studied, 15.6% had prolonged hospital stay, 9.1% had 30-day morbidity, 0.7% had readmission, and mortality was 1.1%. High-risk scores on the ASA and CFS were significantly associated with prolonged postoperative stay, readmission, morbidity, and mortality (p < 0.05). High-risk scores on the ECOG was significantly associated with prolonged hospital stay (p = 0.027), 30-day morbidity (p = 0.003), and mortality (p = 0.001), but not with readmission. There was no significant association between MFI score and the postoperative variables studied (p > 0.05). On multivariate analysis, morbidity was significantly associated only with male gender (p = 0.015), higher cancer stage (p = 0.005), higher ASA score (p = 0.029), and prolonged hospital stay (p = 0.001). Mortality was significantly associated only with emergency surgery (p = 0.012) and prolonged hospital stay (p = 0.004), and prolonged hospital stay was significantly associated with advanced cancer stage (p = 0.001) and emergency surgery (p = 0.02). CONCLUSIONS In older patients undergoing cancer surgery, ASA and CFS are predictors of prolonged postoperative stay, morbidity, mortality, and readmission. A high-risk ECOG score is predictive of prolonged post operative stay, 30-day morbidity, and mortality, but not of readmission. Score on MFI is not a predictor of postoperative outcomes. Newer predictive tools which include cancer- specific factors are required for better management of these patients.
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Meng Y, Zhao P, Yong R. Modified Frailty Index Independently Predicts Postoperative Pulmonary Infection in Elderly Patients Undergoing Radical Gastrectomy for Gastric Cancer. Cancer Manag Res 2021; 13:9117-9126. [PMID: 34924772 PMCID: PMC8675092 DOI: 10.2147/cmar.s336023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Background Pulmonary infection is one of the most common postoperative complications after radical gastrectomy for gastric cancer (GC) and is associated with a poorer prognosis. This study aimed to investigate potential predictive factors for pulmonary infection in elderly GC patients. Methods This study retrospectively enrolled 346 elderly GC patients undergoing elective radical gastrectomy between January 2017 and December 2020. Pulmonary infection within postoperative 30 days was set as the primary observational endpoint. The baseline demographic, clinicopathological, and laboratory data were compared between patients with or without pulmonary infection. ROC curves were plotted to evaluate the cut-off and predictive values of factors. Binary univariate and multivariate logistic regression analyses were employed to determine risk factors for postoperative pulmonary infection. Results Of the enrolled 346 patients, pulmonary infection was observed in 51 patients within postoperative 30 days, with an incidence of 14.7%. mFI was a significant predictor for pulmonary infection by ROC curve analysis (AUC: 0.770, P < 0.001). Moreover, preoperative mFI was the only independent risk factor for pulmonary infection (OR: 2.72, 95% CI: 2.02–3.31, P = 0.011) by univariate and multivariate logistic regression analyses. Conclusion Our study indicates that mFI independently predicts pulmonary infection in elderly GC patients.
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Affiliation(s)
- Yongsheng Meng
- Department of Anesthesiology, Taizhou People's Hospital, Taizhou, Jiangsu, People's Republic of China
| | - Pengfei Zhao
- Department of Anesthesiology, Taizhou People's Hospital, Taizhou, Jiangsu, People's Republic of China
| | - Rong Yong
- Department of Anesthesiology, Taizhou People's Hospital, Taizhou, Jiangsu, People's Republic of China
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Rittberg R, Zhang H, Lambert P, Kudlovich R, Kim CA, Dawe DE. Utility of the modified frailty index in predicting toxicity and cancer outcomes for older adults with advanced pancreatic cancer receiving first-line palliative chemotherapy. J Geriatr Oncol 2020; 12:112-117. [PMID: 32798212 DOI: 10.1016/j.jgo.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/25/2020] [Accepted: 07/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatic cancer primarily affects older adults and is associated with a high morbidity and mortality. Identifying frail patients with advanced pancreatic cancer (APC) helps to mitigate the risks of chemotherapy (CT). The modified Frailty Index (mFI) is an 11-point deficit measure used to identify frail patients. Although validated in surgical fields, it has not been assessed in an APC population. METHODS A retrospective cohort study evaluated consecutive patients, aged ≥65 years, diagnosed with APC from 2011 to 2016 and treated with first line palliative-intent CT. mFI was categorized as: 0, 1, 2 and ≥ 3. Descriptive analysis was completed comparing patient characteristics, CT toxicity, response to treatment, and overall survival (OS) by mFI score. RESULTS 87 patients with APC received palliative CT. Median age was 71 (65-88), 54% male. A mFI score of 0, 1, 2, and ≥ 3 occurred for 20 (23%), 28 (32.2%), 25 (28.7%) and 14 (16.1%) patients respectively. Patients with mFI scores of 0-1 were more likely to receive: 5-fluorouracil, irinotecan and oxaliplatin. CT toxicity, emergency room (ED) and urgent cancer clinic (UCC) presentation, and hospitalization length did not differ by mFI. Longer OS was associated with better ECOG and receipt of combination CT. CONCLUSION This is the first assessment of the mFI in an APC population receiving CT. The mFI score did not correlate with toxicity, ED/UCC visits, hospitalization length or OS. Ongoing assessment of tools that accurately identify frailty in patients with APC is critical to help better select candidates for aggressive CT.
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Affiliation(s)
- Rebekah Rittberg
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook St, R3A 1R9 Winnipeg, MB, Canada; CancerCare Manitoba, Department of Hematology and Medical Oncology, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada.
| | - Hanbo Zhang
- Cross Cancer Institute, Department of Oncology, 8440 112 St. NW, T6G 2R7 Edmonton, AB, Canada.
| | - Pascal Lambert
- CancerCare Manitoba, Department of Epidemiology, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada.
| | - Robert Kudlovich
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook St, R3A 1R9 Winnipeg, MB, Canada.
| | - Christina A Kim
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook St, R3A 1R9 Winnipeg, MB, Canada; CancerCare Manitoba, Department of Hematology and Medical Oncology, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada.
| | - David E Dawe
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook St, R3A 1R9 Winnipeg, MB, Canada; CancerCare Manitoba, Department of Hematology and Medical Oncology, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave, R3E 0V9 Winnipeg, MB, Canada.
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Laube R, Wang H, Park L, Heyman JK, Vidot H, Majumdar A, Strasser SI, McCaughan GW, Liu K. Frailty in advanced liver disease. Liver Int 2018; 38:2117-2128. [PMID: 29935102 DOI: 10.1111/liv.13917] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/20/2018] [Indexed: 12/15/2022]
Abstract
Prognostication of patients with cirrhosis is complex, depending on more than just the severity of liver disease. Scores such as the model for end-stage liver disease (MELD) and Child Pugh can assist with prognostication, yet by focusing on physiological parameters they fail to completely capture the elements contributing to a patient's clinical status. Evidence is increasing to support an important role for physical functioning in patient outcomes. Frailty has been increasingly recognised in medical literature over recent years, including in hepatology where it is identified in nearly half of cirrhosis patients. It is a complex construct consisting of multisystemic physiological decline and increased vulnerability to stressors. Diagnosis is complicated by lack of a consensus definition and measurement tool for frailty in cirrhosis. Frailty heralds a poor prognosis, predicting increased morbidity and mortality both pre- and postliver transplant, independent of MELD score. It is thought to be reversible, with promising data supporting prehabilitation and lifestyle intervention programs. In the future, assessment of patients with cirrhosis is likely to incorporate a measure of frailty, however, further research is required.
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Affiliation(s)
- Robyn Laube
- Gastroenterology and Liver Services, Concord Hospital, Sydney, NSW, Australia
| | - Hogan Wang
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Laura Park
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Joanne K Heyman
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Helen Vidot
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Simone I Strasser
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Geoffrey W McCaughan
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Liver Injury and Cancer Program, Centenary Institute, The University of Sydney, Sydney, NSW, Australia
| | - Ken Liu
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Liver Injury and Cancer Program, Centenary Institute, The University of Sydney, Sydney, NSW, Australia
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