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The clinical impact of frailty on the postoperative outcomes of patients undergoing gastrectomy for gastric cancer: a propensity-score matched database study

Published: November 13, 2021
Category: Bibliography
Authors: David Jeffrey Hastie, David Uihwan Lee, Gregory Hongyuan Fan, Jean Kwon, John Han, Ki Jung Lee, Raffi Karagozian
Country: United States
Language: English
Types: Health Risk, Surgical Care
Setting: Hospital

Abstract

Background

Frailty aggregates a composite of geriatric and elderly features that is classified into a singular syndrome; literature thus far has proven its influence over postoperative outcomes. In this study, we evaluate the effects of frailty following gastrectomy for gastric cancer.

Methods

2011–2017 National Inpatient Sample was used to isolate patients with gastric cancer undergoing gastrectomy; from this, the Johns Hopkins ACG frailty criteria were applied to segregate frailty-present and absent populations. The case–controls were matched using propensity-score matching and compared to various endpoints.

Results

Post match, there were 1171 with and without frailty who were undergoing gastrectomy for gastric cancer. Those with frailty had higher mortality (6.83 vs 3.50% p < 0.001, OR 2.02 95% CI 1.37–2.97), length of stay (16.7 vs 12.0d; p < 0.001), and costs ($191,418 vs $131,367; p < 0.001); frail patients also had higher rates of complications including wound complications (3.42 vs 0.94% p < 0.001, OR 3.73 95% CI 1.90–7.31), infection (5.98 vs 3.67% p = 0.012, OR 1.67 95% CI 1.13–2.46), and respiratory failure (6.32 vs 3.84% p = 0.0084, OR 1.69 95% CI 1.15–2.47). In multivariate, those with frailty had higher mortality (p < 0.001, aOR 2.04 95% CI 1.38–3.01), length of stay (p < 0.001, aOR 1.40 95% CI 1.37–1.43), and costs (p < 0.001, aOR 1.46 95% CI 1.46–1.46).

Conclusion

This study finding demonstrates the presence of frailty is an independent risk factor of adverse outcomes following gastrectomy; as such, it is important that these high-risk patients are stratified preoperatively and provided risk-averting procedures to alleviate their frailty-defining features.

frailty,high risk patients,gastrectomy outcomes,preop stratification

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