Background
To assess the effect of frailty on morbidity and mortality after partial pancreatectomy.
Methods
A retrospective analysis of National Surgical Quality Improvement Project from 2005–2010
was conducted. A modified frailty index was created based on previously validated
methodology. Patients were classified as nonfrail, low frailty, intermediate frailty,
and frail. Outcomes of pancreatoduodenectomy and distal pancreatectomy were examined.
Results
In the study, 13,020 patients were analyzed (8,729 pancreatoduodenectomy and 4,291
distal pancreatectomy). Among the pancreatoduodenectomy and distal pancreatectomy
patients, frail patients regardless of the degree of frailty were older, more likely
male, had a greater body mass index, lower serum albumin, and greater weight loss
compared with the nonfrail patients (all P ≤ .05). Postoperatively, a stepwise increased risk of grade 4 complications (Clavien/Dindo)
and mortality was noted from nonfrail to frail patients. Every 1-point increase in
modified frailty index was associated with a significantly increased risk of grade
4 complications (∼2–6 times) and mortality (∼2–10 times) from low-frail to frail (adjusted
for age, sex, body mass index, albumin, weight loss, and type of pancreatectomy).
An abbreviated frailty index incorporating 8 variables was as predictive as the modified
frailty index (P = .68).
Conclusion
An 11-point frailty index as measured in National Surgical Quality Improvement Project
predicts serious complications and death after pancreatectomy. A modification of this
index with 8 factors continues to have similar predictive ability. Consideration of
frailty may be beneficial prior to the pancreatic surgeon and particularly in discussion
of operative risk and selection of patients who might receive benefit from pre-operative
optimization.
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Article info
Publication history
Published online: August 18, 2016
Accepted:
July 11,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
