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Paiella S, De Pastena M, Esposito A, Secchettin E, Casetti L, Malleo G, Montagnini G, Bannone E, Deiro G, Bampa B, Ramera M, Landoni L, Balduzzi A, Bassi C, Salvia R. Modified Frailty Index to Assess Risk in Elderly Patients Undergoing Distal Pancreatectomy: A Retrospective Single-Center Study. World J Surg 2022; 46:891-900. [PMID: 35024923 PMCID: PMC8885554 DOI: 10.1007/s00268-021-06436-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/02/2022]
Abstract
Background To compare the postoperative course of elderly patients (≥70 years) submitted to minimally invasive (MIDP) versus open distal pancreatectomy (ODP) and to evaluate if the modified Frailty Index (mFI) predicts the surgical course of elderly patients submitted to DP. Methods Data of patients aged ≥70 who underwent DP at a single institution between March 2011 and December 2019 were retrospectively retrieved. A 2:1 propensity score matching (PSM) was used to correct for differences in baseline characteristics. Then, postoperative complications were compared between the two groups (MIDP vs. ODP). Additionally, the entire cohort of DP elderly patients was stratified according to the mFI into three groups: non-frail (mFI = 0), mildly frail (mFI = 1/2), or severely frail (mFI = 3) and then compared. Results A total of 204 patients were analyzed. After PSM, 40 MIDP and 80 ODP patients were identified. The complications considered stratified homogenously between the two groups, with no statistically significant differences. The severity of the postoperative course increased as mFI did among the three groups regarding any complication (p = 0.022), abdominal collection (p = 0.014), pulmonary complication (p = 0.001), postoperative confusion (p = 0.047), Clavien-Dindo severity ≥3 events (p = 0.036), and length of stay (p = 0.018). Conclusions Elderly patients can be safely submitted to MIDP. The mFI identifies frail elderly patients more prone to develop surgical and non-surgical complications after DP. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06436-2.
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Affiliation(s)
- Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Matteo De Pastena
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Alessandro Esposito
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy. .,Referent of the Mini-Invasive Pancreatic Laparoscopic and Robotic Surgery of the General and Pancreatic Surgery Unit, Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134, Verona, Italy.
| | - Erica Secchettin
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Luca Casetti
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Greta Montagnini
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Elisa Bannone
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Giacomo Deiro
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Beatrice Bampa
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Marco Ramera
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Luca Landoni
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Alberto Balduzzi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
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