Use of a simplified frailty index to predict Clavien 4 complications and mortality after hepatectomy: analysis of the National Surgical Quality Improvement Project database

American Journal of Surgery
Lisa LouwersIlan Rubinfeld

Abstract

An aging surgical population places an increasing burden on surgeons to accurately risk stratify and counsel patients. Preoperative frailty assessments are a promising new modality to better evaluate patients but can often be time consuming. Data regarding frailty and hepatectomy outcomes have not been published to date. Using the National Surgical Quality Improvement Project database, we examined hepatectomy patients 2005 to 11 and correlated frailty scores with outcomes of major morbidity, mortality, and extended length of stay, using a previously validated modified frailty index score. Frailty was compared against age, American Society of Anesthesiologists class, and other common risk variables. Multivariate regression identified frailty as the strongest predictor of Clavien 4 complications (OR = 40.0, 95% CI = 15.2 to 105.0), and mortality (OR = 26.4, 95% CI = 7.7 to 88.2). As the frailty score increased, there was a statistically significant increase in Clavien 4 complications, mortality, and extended length of stay (P < .001 for all). Frailty is a significant factor in morbidity and mortality after hepatectomy. Use of the modified frailty index allows for feasibility of data collection in a busy clinical setting.

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Citations

Apr 25, 2017·Journal of Surgical Oncology·Sarah A VermillionClancy J Clark
Mar 16, 2017·Current Opinion in Anaesthesiology·Lior Shem Tov, Idit Matot
Feb 1, 2018·Updates in Surgery·Gianluca CostaUNKNOWN ERASO (Elderly Risk Assessment for Surgical Outcome) Collaborative Study Group
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Jun 28, 2018·Journal of Hepato-biliary-pancreatic Sciences·Shogo TanakaShoji Kubo
Apr 16, 2020·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·D S KellerS K Nemeth
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Mar 4, 2017·Biogerontology·A B MitnitskiK Rockwood
Mar 24, 2021·BMJ Open·Gemma F SpiersBarbara Hanratty
Nov 7, 2020·The American Surgeon·Tyler McKechniePablo E Serrano

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