Brief Preoperative Frailty Screening Predicts Adverse Postoperative Outcomes in Elderly Patients with Radical Esophageal Cancer Surgery

Abstract

Abstract Background Frailty is increasingly becoming a powerful prognostic factor for cancer patients after surgery. The purpose of this study was to explore the prognostic value of 5-modified frailty index (mFI-5) in postoperative mortality and major morbidity in patients with esophageal cancer over 65 years of age. Methods Data comes from the largest database of esophageal cancer patients in China. A total of 699 patients over 65 years old who underwent primary esophagectomy from January 1, 2014 to January 31, 2017. mFI-5 variables include hypertension, type Ⅱ diabetes, congestive heart failure, chronic obstructive pulmonary disease, and independent functional status. 1 point is assigned to each variable. Patients were divided into 3 groups based on their mFI-5: frail group (mFI-5, 2–5), prefrail group (mFI-5, 1) and robust group (mFI-5, 0). The primary outcome was 30-day mortality. Secondary outcomes were postoperative pneumonia and postoperative delirium. Results A total of 699 patients were included in the cohort study. Frailty group had the highest incidence of postoperative delirium (frailty: 22.5% vs. prefrailty : 14.7% vs. robust : 2.9%; p < 0.001), postoperative pneumonia (frailty : 13.3% vs. prefrailty : 9.8% vs. robust : 3.8%; p < 0.001), and 30-day mortality (frailty: 5.8% vs. prefrailty : 1.6% vs. robust: 1.2%; p < 0.001). Multivariate analysis showed that frailty was associated with a significantly increased risk of postoperative delirium (aOR, 6.82; 95% confidence interval (CI), 3.12–14.89; p < 0.001), postoperative pneumonia (aOR, 4.12; 95%CI, 2.52–5.72; p < 0.001) and 30-day mortality (aOR, 14.30; 95%CI, 4.87–42.03; p < 0.001). Conclusions Frailty, as determined by mFI-5, is associated with increased odds of postoperative delirium, postoperative pneumonia, and 30-day mortality in patients undergoing radical esophagectomy.