Self-reported exhaustion and a 4-item physical frailty index to predict the incidence of major complications after onco-geriatric surgery

Kathrin Scholtz; Friedrich Borchers; Rudolf Mörgeli; Henning Krampe; Maren Schmidt; Rahel Eckardt-Felmberg; Vera von Dossow; Jalid Sehouli; Christian G Stief; Anne Pohrt; Claudia D Spies; PERATECS Group

doi:10.1016/j.ejso.2024.108421

Self-reported exhaustion and a 4-item physical frailty index to predict the incidence of major complications after onco-geriatric surgery

Eur J Surg Oncol. 2024 Jul;50(7):108421. doi: 10.1016/j.ejso.2024.108421. Epub 2024 May 23.

Authors

Collaborators

PERATECS Group:
Edith Weiß-Gerlach¹², Anwar Al-Hashem¹², Susanne Braun¹³, Frederik Brinkmann¹², Anna-Maria Collette¹², Franziska Degel¹², Frederic de Beukelaer¹², Susanne Geue¹², Kerstin Hartmann¹², Saskia Hennig¹², Inga Hoffmann¹², Oskar Mohr¹², Georgi Petrov¹²

Affiliations

¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany. Electronic address: [email protected].
² Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany. Electronic address: [email protected].
³ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany. Electronic address: [email protected].
⁴ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany. Electronic address: [email protected].
⁵ Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Schlosspark-Klinik Berlin, Heubnerweg 2, 14059, Berlin, Germany. Electronic address: [email protected].
⁶ St. Joseph Krankenhaus Berlin-Tempelhof GmbH, Wüsthoffstraße 15, 12101, Berlin, Germany. Electronic address: [email protected].
⁷ Institute of Anesthesiology and Pain Therapy, Heart, and Diabetes Center NRW, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany. Electronic address: [email protected].
⁸ Department of Gynecology, European Competence Center of Ovarian Cancer, Charité Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. Electronic address: [email protected].
⁹ Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. Electronic address: [email protected].
¹⁰ Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany. Electronic address: [email protected].
¹¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany. Electronic address: [email protected].
¹² Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353, Berlin, Germany.
¹³ Department of Anesthesiology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.

PMID: 38870573
DOI: 10.1016/j.ejso.2024.108421

Abstract

Background: The aim of this study was to analyze four pre-operative physical frailty indicators from a geriatric assessment (GA) independently and combined in a physical frailty index, in their ability to predict postoperative 30 d-complications.

Materials and methods: In this secondary analysis of data from the published PERATECS study (ClinicalTrials.gov: NCT01278537), the predictive value of four physical frailty indicators from a defined GA battery was examined with univariable and multivariate logistic regression models in a sample of 493 onco-geriatric surgical patients. The primary endpoint was incidence of major (Clavien-Dindo ≥ grade 2 [CD ≥ 2]) complications within 30 postoperative days. Predictors of the first model included self-reported exhaustion (SRE), body mass index (BMI), Timed Up-and-Go (TUG) and handgrip strength (HGS) independently, and a second model combined these four items as a Physical Frailty Index (4i-PFI). Both regression models were adjusted for age, gender, American Society of Anesthesiologists (ASA) status, tumor sites, duration of surgery time and Mini Nutritional Assessment (MNA) score.

Results: A total of 233 patients (47 %) developed CD ≥ 2 complications. In addition to ASA score, length of surgery, and gynecological and upper gastrointestinal tumor sites, the first model showed that SRE (OR 1.866) predicted CD ≥ 2 complications, but not TUG, BMI and HGS. In the second model, the 4i-PFI predicted CD ≥ 2 complications (OR pre-frail = 1.808, frail = 3.787).

Conclusions: Physical frailty indicators as SRE revealed a better ability to predict CD ≥ 2 complications than BMI, TUG and HGS. However, prediction of CD ≥ 2 complications was enhanced when these parameters were combined in a novel 4i-PFI.

Keywords: Clavien-Dindo; Fried's phenotype; Gastric cancer surgery geriatric assessment; Gynecological cancer surgery; Oncologic cancer surgery.

MeSH terms

Aged
Aged, 80 and over
Body Mass Index
Fatigue / epidemiology
Fatigue / etiology
Female
Frail Elderly
Frailty* / epidemiology
Geriatric Assessment*
Hand Strength*
Humans
Incidence
Male
Neoplasms* / surgery
Postoperative Complications* / epidemiology
Self Report*

Associated data

ClinicalTrials.gov/NCT01278537