Abstract：
BACKGROUND: Gastric cancer is the 5th most common malignancy worldwide. Surgical treatment for the disease can often be highly morbid, especially in elderly patients. The modified 5-item frailty index (mFI-5), a recently developed tool for assessing patient frailty, has been shown to be an effective predictor of post-operative outcomes in various surgical fields. This study aims to assess the utility of the mFI-5 in predicting adverse postoperative outcomes following gastrectomy for gastric cancer.
METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent partial or total gastrectomy for gastric cancer between 2011 and 2021. The mFI-5 score was calculated based on the presence of hypertension, congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, and partially or fully dependent functional status. Patients were stratified into 3 groups according to mFI-5 score (mFI-5 = 0, mFI-5 = 1, mFI-5 ≥ 2). Univariate analysis and multivariate logistic regression were used to evaluate the association between mFI-5 score and post-operative outcomes.
RESULTS: 7438 patients were identified (mFI-5 = 0: 3032, mFI-5 = 1: 2805, mFI-5 ≥ 2: 1601). mFI-5 ≥ 2 was an independent predictor of overall complications (OR 1.43, p < 0.001), serious complications (OR 1.42, p < 0.001), pneumonia (OR 1.43, p = 0.010), MI (OR 2.91, p = 0.005), and readmission within 30 days (OR 1.33, p = 0.008). Patients with higher frailty were more likely to experience unplanned intubation (OR 2.06, p < 0.001; OR 2.47, p < 0.001), failure to wean from the ventilator (OR 1.68, p = 0.003; OR 2.00, p < 0.001), acute renal failure (OR 3.25, p = 0.003; OR 3.27, p = 0.005), 30-day mortality (OR 1.73, p = 0.009; OR 1.94, p = 0.004), and non-home discharge (OR 1.34, p = 0.001; OR 1.74, p < 0.001) relative to non-frail patients.
CONCLUSIONS: Higher frailty, as indicated by an increased mFI-5 score, raises the risk of serious post-operative complications in patients with gastric cancer undergoing gastrectomy. The mFI-5 has the potential to help identify high-risk patients and enhance pre-operative discussions and optimization.
METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent partial or total gastrectomy for gastric cancer between 2011 and 2021. The mFI-5 score was calculated based on the presence of hypertension, congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, and partially or fully dependent functional status. Patients were stratified into 3 groups according to mFI-5 score (mFI-5 = 0, mFI-5 = 1, mFI-5 ≥ 2). Univariate analysis and multivariate logistic regression were used to evaluate the association between mFI-5 score and post-operative outcomes.
RESULTS: 7438 patients were identified (mFI-5 = 0: 3032, mFI-5 = 1: 2805, mFI-5 ≥ 2: 1601). mFI-5 ≥ 2 was an independent predictor of overall complications (OR 1.43, p < 0.001), serious complications (OR 1.42, p < 0.001), pneumonia (OR 1.43, p = 0.010), MI (OR 2.91, p = 0.005), and readmission within 30 days (OR 1.33, p = 0.008). Patients with higher frailty were more likely to experience unplanned intubation (OR 2.06, p < 0.001; OR 2.47, p < 0.001), failure to wean from the ventilator (OR 1.68, p = 0.003; OR 2.00, p < 0.001), acute renal failure (OR 3.25, p = 0.003; OR 3.27, p = 0.005), 30-day mortality (OR 1.73, p = 0.009; OR 1.94, p = 0.004), and non-home discharge (OR 1.34, p = 0.001; OR 1.74, p < 0.001) relative to non-frail patients.
CONCLUSIONS: Higher frailty, as indicated by an increased mFI-5 score, raises the risk of serious post-operative complications in patients with gastric cancer undergoing gastrectomy. The mFI-5 has the potential to help identify high-risk patients and enhance pre-operative discussions and optimization.
摘要：
背景：胃癌是全球第五大最常见的恶性肿瘤。这种疾病的手术治疗通常是高度病态的，尤其是老年患者。修改后的5项脆弱指数(mFI-5)，最近开发的评估病人虚弱的工具，已被证明是各种手术领域术后结果的有效预测指标。本研究旨在评估mFI-5在预测胃癌胃切除术后不良预后中的实用性。
方法：国家外科质量改进计划（NSQIP）数据库查询了2011年至2021年期间接受部分或全胃切除术治疗胃癌的患者。根据高血压的存在计算mFI-5评分，充血性心力衰竭,糖尿病,慢性阻塞性肺疾病,以及部分或完全依赖的功能状态。根据mFI-5评分将患者分为3组(mFI-5=0,mFI-5=1,mFI-5≥2)。采用单因素分析和多因素logistic回归分析mFI-5评分与术后结局的相关性。
结果：7438例患者（mFI-5=0:3032，mFI-5=1:2805，mFI-5≥2:1601）。mFI-5≥2是总并发症的独立预测因子(OR1.43,p<0.001),严重并发症（OR1.42，p<0.001），肺炎（OR1.43，p=0.010），MI（OR2.91，p=0.005），30天内再入院（OR1.33，p=0.008）。虚弱程度较高的患者更有可能经历非计划插管(OR2.06,p<0.001;OR2.47,p<0.001),未能从呼吸机上断奶（OR1.68，p=0.003；OR2.00，p<0.001），急性肾功能衰竭（OR3.25，p=0.003；OR3.27，p=0.005），30天死亡率（OR1.73，p=0.009；OR1.94，p=0.004），和非家庭出院（OR1.34，p=0.001；OR1.74，p<0.001）相对于非虚弱患者。
结论：更脆弱，如mFI-5分数增加所示，增加了胃癌患者术后严重并发症的风险。mFI-5有可能帮助识别高风险患者，并加强术前讨论和优化。
方法：国家外科质量改进计划（NSQIP）数据库查询了2011年至2021年期间接受部分或全胃切除术治疗胃癌的患者。根据高血压的存在计算mFI-5评分，充血性心力衰竭,糖尿病,慢性阻塞性肺疾病,以及部分或完全依赖的功能状态。根据mFI-5评分将患者分为3组(mFI-5=0,mFI-5=1,mFI-5≥2)。采用单因素分析和多因素logistic回归分析mFI-5评分与术后结局的相关性。
结果：7438例患者（mFI-5=0:3032，mFI-5=1:2805，mFI-5≥2:1601）。mFI-5≥2是总并发症的独立预测因子(OR1.43,p<0.001),严重并发症（OR1.42，p<0.001），肺炎（OR1.43，p=0.010），MI（OR2.91，p=0.005），30天内再入院（OR1.33，p=0.008）。虚弱程度较高的患者更有可能经历非计划插管(OR2.06,p<0.001;OR2.47,p<0.001),未能从呼吸机上断奶（OR1.68，p=0.003；OR2.00，p<0.001），急性肾功能衰竭（OR3.25，p=0.003；OR3.27，p=0.005），30天死亡率（OR1.73，p=0.009；OR1.94，p=0.004），和非家庭出院（OR1.34，p=0.001；OR1.74，p<0.001）相对于非虚弱患者。
结论：更脆弱，如mFI-5分数增加所示，增加了胃癌患者术后严重并发症的风险。mFI-5有可能帮助识别高风险患者，并加强术前讨论和优化。
