Effect of preoperative frailty on postoperative complications in elderly patients with esophageal cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Jiaqi ¹ , WU Jingxiang ¹ , YAO Haixia ¹ , LI Bin ² ,  MIAO Qing ¹

1. Department of Anesthesiology, Shanghai Chest Hospital, Chest Hospital Affiliated to Medical College of Shanghai Jiao Tong University, Shanghai, 200030, P. R. China;
2. Department of Thoracic Surgery, Shanghai Chest Hospital, Chest Hospital Affiliated to Medical College of Shanghai Jiao Tong University, Shanghai, 200030, P. R. China;

Corresponding author：

MIAO Qing, Email: miaoqmz@163.com

Keywords：

Frailty; elderly patients; esophageal cancer; complications

DOI：

10.7507/1007-4848.202203050

Video：

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Objective To evaluate the effect of frailty on postoperative complications in elderly patients with esophageal cancer.Methods We enrolled the patients aged≥65 years and with esophageal cancer who underwent surgical treatment in Shanghai Chest Hospital in 2021. The modified frailty index (mFI) was calculated and the patients were divided into a non-frailty group and a frailty group. The primary outcomes were the incidence of postoperative pulmonary infection, arrhythmia, anastomotic fistula and chylothorax complications. Secondary outcomes were the time of extubation, the rate of unplanned re-intubation, the length of ICU stay, hospital stay, rate of readmission within 30 days after discharge and the mortality within 30 days after operation.Results Finally 607 patients were collected. There were 273 patients in the non-frailty group and 334 patients in the frailty group. The non-frailty group had lower rates of complications including pulmonary infection (5.5% vs. 13.5%), arrhythmia (3.7% vs. 9.3%), anastomotic fistula (2.9% vs. 7.5%), and shorter ICU stay [2.0 (0.0, 4.0) d vs. 4.0 (1.0, 6.0) d] and in-hospital stay [11.5 (9.5, 13.0) d vs. 13.0 (11.0, 18.0) d],lower rates of the readmission within 30 days (2.9% vs. 6.6%) and the mortality within 30 days (0.4% vs. 1.2%) compared with the frailty group (P<0.05).Conclusion Frail elderly patients with esophageal cancer have higher rates of postoperative complications. mFI can be used as an objective index to identify high-risk elderly patients with esophageal cancer.

Citation： GUO Jiaqi, WU Jingxiang, YAO Haixia, LI Bin, MIAO Qing. Effect of preoperative frailty on postoperative complications in elderly patients with esophageal cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(8): 1169-1174. doi: 10.7507/1007-4848.202203050 Copy

1.	Kusumastuti S, Hoogendijk EO, Gerds TA, et al. Do changes in frailty, physical functioning, and cognitive functioning predict mortality in old age? Results from the Longitudinal Aging Study Amsterdam. BMC Geriatr, 2022, 22(1): 193.
2.	Zak M, Sikorski T, Wasik M, et al. Frailty syndrome-fall risk and rehabilitation management aided by virtual reality (VR) technology solutions: A narrative review of the current literature. Int J Environ Res Public Health, 2022, 19(5): 2985.
3.	DeMaria S, Khromava M, Schiano TD, et al. Standardized measures of frailty predict hospital length of stay following orthotopic liver transplantation for hepatocellular carcinoma. Clin Transplant, 2019, 33(12): e13746.
4.	Darvall JN, Gregorevic KJ, Story DA, et al. Frailty indexes in perioperative and critical care: A systematic review. Arch Gerontol Geriatr, 2018, 79: 88-96.
5.	Hamidi M, Zeeshan M, Leon-Risemberg V, et al. Frailty as a prognostic factor for the critically ill older adult trauma patients. Am J Surg, 2019, 218(3): 484-489.
6.	Zheng C, Luo C, Xie K, et al. Surgical Apgar score could predict complications after esophagectomy: A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg, 2022, 35(1): ivac045.
7.	Xia Z, Gu T, Zhao Z, et al. The stress hyperglycemia ratio, a novel index of relative hyperglycemia, predicts short-term mortality in critically ill patients after esophagectomy. J Gastrointest Oncol, 2022, 13(1): 56-66.
8.	Xu SJ, Lin LQ, Chen C, et al. Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma. Ann Transl Med, 2022, 10(4): 161.
9.	Dezube AR, Cooper L, Mazzola E, et al. Perioperative esophagectomy outcomes in older esophageal cancer patients in two different time eras. Semin Thorac Cardiovasc Surg, 2022, S1043-0679(22): 00044-2.
10.	Mathur S, Prince L, Bucher O, et al. 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(5): 654-661.
11.	Ruiz de Gopegui Miguelena P, Martínez Lamazares MT, Claraco Vega LM, et al. Evaluating frailty may complement APACHE Ⅱ in estimating mortality in elderly patients admitted to the ICU after digestive surgery. Med Intensiva (Engl Ed), 2022, 46(5): 239-247.
12.	Huh JY, Matsuoka Y, Kinoshita H, et al. Premorbid Clinical Frailty Score and 30-day mortality among older adults in the emergency department. J Am Coll Emerg Physicians Open, 2022, 3(1): e12677.
13.	Zanetti M, De Colle P, Omiciuolo C, et al. Postoperative dehydration is associated with frailty and decreased survival in older patients with hip fracture. Nutrients, 2022, 14(4): 820.
14.	Soh CH, Guan L, Reijnierse EM, et al. Comparison of the modified Frailty-Index based on laboratory tests and the Clinical Frailty Scale in predicting mortality among geriatric rehabilitation inpatients: RESORT. Arch Gerontol Geriatr, 2022, 100: 104667.
15.	Akhtar M, Donnachie DJ, Siddiqui Z, et al. Hierarchical regression of ASA prediction model in predicting mortality prior to performing emergency laparotomy a systematic review. Ann Med Surg (Lond), 2020, 60: 743-749.
16.	Ahmad M, Shaikh A, Ahmad AS, et al. Enhanced recovery program—Impact of ASA grade on length of hospital stay in patients undergoing hip and knee arthroplasties. Surgeon, 2022, S1479-666X(22): 00017-8.
17.	于媛, 李敏, 康然, 等. 加速康复模式下食管癌患者术后1个月症状群研究. 护理管理杂志, 2021, 21(3): 179-183.
18.	贺宇彤, 梁迪, 杜灵彬, 等. 5283例食管癌患者的临床特征和生存: 中国6个地区18家医院的多中心研究. 癌症, 2021, 40(3): 113-126.
19.	Bailey DM, Halligan CL, Davies RG, et al. Subjective assessment underestimates surgical risk: On the potential benefits of cardiopulmonary exercise testing for open thoracoabdominal repair. J Card Surg, 2022, 37(8): 2258-2265.
20.	Maegawa FB, Ahmad M, Aguirre K, et al. The impact of minimally invasive surgery and frailty on post-hepatectomy outcomes. HPB (Oxford), 2022, 24(9): 1577-1584.

1. Kusumastuti S, Hoogendijk EO, Gerds TA, et al. Do changes in frailty, physical functioning, and cognitive functioning predict mortality in old age? Results from the Longitudinal Aging Study Amsterdam. BMC Geriatr, 2022, 22(1): 193.
2. Zak M, Sikorski T, Wasik M, et al. Frailty syndrome-fall risk and rehabilitation management aided by virtual reality (VR) technology solutions: A narrative review of the current literature. Int J Environ Res Public Health, 2022, 19(5): 2985.
3. DeMaria S, Khromava M, Schiano TD, et al. Standardized measures of frailty predict hospital length of stay following orthotopic liver transplantation for hepatocellular carcinoma. Clin Transplant, 2019, 33(12): e13746.
4. Darvall JN, Gregorevic KJ, Story DA, et al. Frailty indexes in perioperative and critical care: A systematic review. Arch Gerontol Geriatr, 2018, 79: 88-96.
5. Hamidi M, Zeeshan M, Leon-Risemberg V, et al. Frailty as a prognostic factor for the critically ill older adult trauma patients. Am J Surg, 2019, 218(3): 484-489.
6. Zheng C, Luo C, Xie K, et al. Surgical Apgar score could predict complications after esophagectomy: A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg, 2022, 35(1): ivac045.
7. Xia Z, Gu T, Zhao Z, et al. The stress hyperglycemia ratio, a novel index of relative hyperglycemia, predicts short-term mortality in critically ill patients after esophagectomy. J Gastrointest Oncol, 2022, 13(1): 56-66.
8. Xu SJ, Lin LQ, Chen C, et al. Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma. Ann Transl Med, 2022, 10(4): 161.
9. Dezube AR, Cooper L, Mazzola E, et al. Perioperative esophagectomy outcomes in older esophageal cancer patients in two different time eras. Semin Thorac Cardiovasc Surg, 2022, S1043-0679(22): 00044-2.
10. Mathur S, Prince L, Bucher O, et al. 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(5): 654-661.
11. Ruiz de Gopegui Miguelena P, Martínez Lamazares MT, Claraco Vega LM, et al. Evaluating frailty may complement APACHE Ⅱ in estimating mortality in elderly patients admitted to the ICU after digestive surgery. Med Intensiva (Engl Ed), 2022, 46(5): 239-247.
12. Huh JY, Matsuoka Y, Kinoshita H, et al. Premorbid Clinical Frailty Score and 30-day mortality among older adults in the emergency department. J Am Coll Emerg Physicians Open, 2022, 3(1): e12677.
13. Zanetti M, De Colle P, Omiciuolo C, et al. Postoperative dehydration is associated with frailty and decreased survival in older patients with hip fracture. Nutrients, 2022, 14(4): 820.
14. Soh CH, Guan L, Reijnierse EM, et al. Comparison of the modified Frailty-Index based on laboratory tests and the Clinical Frailty Scale in predicting mortality among geriatric rehabilitation inpatients: RESORT. Arch Gerontol Geriatr, 2022, 100: 104667.
15. Akhtar M, Donnachie DJ, Siddiqui Z, et al. Hierarchical regression of ASA prediction model in predicting mortality prior to performing emergency laparotomy a systematic review. Ann Med Surg (Lond), 2020, 60: 743-749.
16. Ahmad M, Shaikh A, Ahmad AS, et al. Enhanced recovery program—Impact of ASA grade on length of hospital stay in patients undergoing hip and knee arthroplasties. Surgeon, 2022, S1479-666X(22): 00017-8.
17. 于媛, 李敏, 康然, 等. 加速康复模式下食管癌患者术后1个月症状群研究. 护理管理杂志, 2021, 21(3): 179-183.
18. 贺宇彤, 梁迪, 杜灵彬, 等. 5283例食管癌患者的临床特征和生存: 中国6个地区18家医院的多中心研究. 癌症, 2021, 40(3): 113-126.
19. Bailey DM, Halligan CL, Davies RG, et al. Subjective assessment underestimates surgical risk: On the potential benefits of cardiopulmonary exercise testing for open thoracoabdominal repair. J Card Surg, 2022, 37(8): 2258-2265.
20. Maegawa FB, Ahmad M, Aguirre K, et al. The impact of minimally invasive surgery and frailty on post-hepatectomy outcomes. HPB (Oxford), 2022, 24(9): 1577-1584.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of preoperative frailty on postoperative complications in elderly patients with esophageal cancer: A retrospective cohort study

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