Association of frailty with 90-day postoperative mortality & geriatric comanagement among older adults with cancer. Issue 4 (April 2022)

• Record Type: Journal Article
• Authors: McMillan, Sincere; Kim, Soo Jung; Tin, Amy L.; Downey, Robert J.; Vickers, Andrew J.; Korc-Grodzicki, Beatriz; Shahrokni, Armin
• Is Part Of: European journal of surgical oncology. Volume 48:Issue 4(2022)
• Page Start: 903
• Page End: 908
• Publication Date: 2022-04
• Subjects: Geriatric oncology -- Frailty -- Surgical outcomes -- Geriatric comanagement; ASA American Society of Anesthesiologists -- CI confidence interval -- MSK Memorial Sloan Kettering Cancer Center -- MSK-FI Memorial Sloan Kettering Frailty Index -- OR odds ratio; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2021.10.019
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: Geriatric medical comanagement of older surgical patients with cancer is associated with lower 90-day postoperative mortality. Here, we investigate the hypothesis that this association varies on the basis of the degree of a patient's frailty. Methods: Frailty was assessed using the Memorial Sloan Kettering Frailty Index. Our hypothesis was evaluated using two approaches, both adjusted for age, sex, American Society of Anesthesiologists Physical Status, preoperative albumin, operating room duration, and estimated blood loss. A logistic regression was performed with 90-day mortality as the outcome and geriatric comanagement, continuous Memorial Sloan Kettering Frailty Index, and an interaction term between these two variables as the primary predictors. We then categorized frailty into four levels and, within each level, performed logistic regression with geriatric comanagement as the primary predictor and 90-day mortality as the outcome. Finally, we extracted the effect size and used a meta-analytic approach to test for heterogeneity. Results: Of 1687 patients aged ≥75 years who underwent elective cancer surgery with a length of stay of ≥1 day, 931 (55%) received comanagement; 31 patients (3.3%) who received comanagement died within 90 days, compared with 72 (9.5%) who did not. Ninety-day mortality was not statistically significantly different by degree of frailty in either analysis (interaction P = 0.4; test of heterogeneity P = 0.8). Conclusion: Geriatric comanagement is valuable for all older surgical patients, not just the frail, and should be provided to as large a portion of the older surgical population as possible. Further research should examine predictors of response to geriatric comanagement.