The five-factor modified frailty index predicts adverse postoperative and chemotherapy outcomes in gynecologic oncology

• Published in: Gynecologic oncology Vol. 166; no. 1; pp. 154 - 161
• Main Authors: Mah, Sarah J., Anpalagan, Tharani, Marcucci, Maura, Eiriksson, Lua, Reade, Clare J., Jimenez, Waldo, Carlson, Vanessa, Van Nguyen, Julie My
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2022
• Subjects: Frailty; Gynecologic oncology; Postoperative morbidity; Risk stratification; Frailty; Gynecologic oncology; Postoperative morbidity; Risk stratification
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2022.05.012

Frailty is increasingly recognized as a predictor of postoperative morbidity and oncologic outcomes. Evidence of the predictive value of frailty assessment in gynecologic oncology remains sparse. To evaluate the National Surgical Quality Improvement Program (NSQIP) comorbidity-based modified Frailty Index-5 (mFI-5) as predictor of severe postoperative complications, non-completion of chemotherapy and other patient-centered outcomes in gynecologic oncology patients >70 years-old undergoing surgery. Prospectively-collected NSQIP data and retrospective chart review of patients undergoing elective laparotomies for gynecologic malignances at a tertiary academic center in Ontario, Canada, between 01/2016–09/2020 were reviewed. Primary outcome was rate of 30-day Clavien-Dindo (Clavien) grade III-V complications. Secondary outcomes included Clavien II-V complications, postoperative length of stay (LOS), non-home discharge and non-completion of chemotherapy. Logistic regression analyses and receiver-operator curves were performed. Two-hundred and fifty-nine patients were included; 103 were planned to receive adjuvant chemotherapy. Fifty-three patients (20.5%) had an mFI ≥ 2 and were categorized as frail. On multivariable analyses, frailty independently predicted grade III-V complications (OR 24.49, 95%CI 9.72–70.67, p < 0.0001), grade II-V complications (OR 4.64, 95%CI 2.31–9.94, p < 0.0001), non-home discharge (OR 7.37, 95%CI 2.81–20.46, p < 0.0001), LOS ≥ 7d (OR 3.6, 95% CI 1.54–8.6, p = 0.003) and non-completion of chemotherapy (OR 8.42, 95%CI 2.46–32.79, p = 0.001). Adjusted C-statistics demonstrated strong predictive value of the mFI-5 for grade III-V (0.92, 95%CI 0.86–0.97) and grade II-V (0.74, 95%CI 0.68–0.8) complications as well as non-home discharge (0.86, 95%CI 0.78–0.95) and chemotherapy non-completion (0.87, 95%CI 0.8–0.95). Frailty as assessed with the mFI-5 predicted adverse postoperative and chemotherapy outcomes in gynecologic oncology patients aged ≥70 undergoing a laparotomy. The mFI-5 is a concise tool that can be used for routine frailty screening and risk stratification. •The mFI-5 predicts postoperative morbidity, chemotherapy non-completion, and non-home discharge in Gynecologic Oncology.•The mFI-5 is brief, objective and easily applied in a clinical setting.•Early frailty assessment may support tailored risk assessment and clinical decision-making.