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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2017

01-06-2017 | Pancreatic Tumors

Modified Frailty Index Predicts Morbidity and Mortality After Pancreaticoduodenectomy

Authors: Harveshp Mogal, MD, Sarah A. Vermilion, BS, Rebecca Dodson, MD, Fang-Chi Hsu, PhD, Russell Howerton, MD, FACS, Perry Shen, MD, FACS, Clancy J. Clark, MD, FACS

Published in: Annals of Surgical Oncology | Issue 6/2017

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Abstract

Background

Pancreatic cancer is a disease of older adults, who may present with limited physiologic reserve. The authors hypothesized that a frailty index can predict postoperative outcomes after pancreaticoduodenectomy (PD).

Methods

All patients who underwent PD were identified in the 2005–2012 NSQIP Participant Use File. Patients undergoing emergency procedures, those with an American Society of Anesthesiologists (ASA) classification of five, and those with a diagnosis of preoperative sepsis were excluded from the study. A modified frailty index (mFI) was defined by 11 variables within the National Surgical Quality Improvement Program (NSQIP) previously used for the Canadian Study of Health and Aging-Frailty Index. An mFI score of 0.27 or higher was defined as a high mFI. Uni- and multivariate analyses were performed to evaluate postoperative outcomes.

Results

This study enrolled 9986 patients (age 65 ± 12 years, 48.8% female) who underwent PD. Of these patients, 6.4% (n = 637) had a high mFI (>0.27). Increasing mFI was associated with higher prevalence of postoperative morbidity (p < 0.001) and 30-days mortality (p < 0.001). In the univariate analysis, high mFI was associated with increased morbidity (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.43–1.97; p < 0.001) and 30-days mortality (OR 2.45; 95% CI 1.74–3.45; p < 0.001). After adjustment for age, sex, ASA classification, albumin level, and body mass index (BMI), high mFI remained an independent preoperative predictor of postoperative morbidity (OR 1.544; 95% CI 1.289–1.850; p < 0.0001) and 30-days mortality (OR 1.536; 95% CI 1.049–2.248; p = 0.027).

Conclusions

High mFI is associated with postoperative morbidity and mortality after PD and can aid in preoperative risk stratification.
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Metadata
Title
Modified Frailty Index Predicts Morbidity and Mortality After Pancreaticoduodenectomy
Authors
Harveshp Mogal, MD
Sarah A. Vermilion, BS
Rebecca Dodson, MD
Fang-Chi Hsu, PhD
Russell Howerton, MD, FACS
Perry Shen, MD, FACS
Clancy J. Clark, MD, FACS
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5715-0

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