Predictive value of frailty assessment tools in patients undergoing surgery for gastrointestinal cancer: An observational cohort study

Hui-Pin Zhang; Hai-Lin Zhang; Xiao-Min Zhou; Guan-Jie Chen; Qi-Fan Zhou; Jie Tang; Zi-Ye Zhu; Wei Wang

doi:10.4240/wjgs.v15.i11.2525

Predictive value of frailty assessment tools in patients undergoing surgery for gastrointestinal cancer: An observational cohort study

World J Gastrointest Surg. 2023 Nov 27;15(11):2525-2536. doi: 10.4240/wjgs.v15.i11.2525.

Authors

Hui-Pin Zhang^{1

2}, Hai-Lin Zhang³, Xiao-Min Zhou⁴, Guan-Jie Chen⁵, Qi-Fan Zhou⁶, Jie Tang⁶, Zi-Ye Zhu⁴, Wei Wang²

Affiliations

¹ Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222061, Jiangsu Province, China.
² Department of Gastrointestinal Surgery, The First People's Hospital of Changzhou, Changzhou 213000, Jiangsu Province, China.
³ Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222061, Jiangsu Province, China. luckihailin@163.com.
⁴ Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222061, Jiangsu Province, China.
⁵ Department of Invasive Technology, Zhongda Hospital Southeast University, Nanjing 210003, Jiangsu Province, China.
⁶ Department of Hemopurification Center, Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222061, Jiangsu Province, China.

Abstract

Background: Few studies have simultaneously compared the predictive value of various frailty assessment tools for outcome measures in patients undergoing gastrointestinal cancer surgery. Therefore, it is difficult to determine which assessment tool is most relevant to the prognosis of this population.

Aim: To investigate the predictive value of three frailty assessment tools for patient prognosis in patients undergoing gastrointestinal cancer surgery.

Methods: This single-centre, observational, prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022. A total of 229 patients aged ≥ 18 years who underwent surgery for gastrointestinal cancer were included in this study. We collected baseline data on the participants and administered three scales to assess frailty: The comprehensive geriatric assessment (CGA), Fried phenotype and FRAIL scale. The outcome measures were the postoperative severe complications and increased hospital costs.

Results: The prevalence of frailty when assessed with the CGA was 65.9%, 47.6% when assessed with the Fried phenotype, and 34.9% when assessed with the FRAIL scale. Using the CGA as a reference, kappa coefficients were 0.398 for the Fried phenotype and 0.291 for the FRAIL scale (both P < 0.001). Postoperative severe complications and increased hospital costs were observed in 29 (12.7%) and 57 (24.9%) patients, respectively. Multivariate logistic analysis confirmed that the CGA was independently associated with increased hospital costs (odds ratio = 2.298, 95% confidence interval: 1.044-5.057; P = 0.039). None of the frailty assessment tools were associated with postoperative severe complications.

Conclusion: The CGA was an independent predictor of increased hospital costs in patients undergoing surgery for gastrointestinal cancer.

Keywords: Assessment tools; Complication; Frailty; Gastrointestinal cancer; Hospital costs; Prognostic.