Frailty: An outcome predictor for elderly gynecologic oncology patients

• Published in: Gynecologic oncology Vol. 126; no. 1; pp. 20 - 24
• Main Authors: Courtney-Brooks, Madeleine, Tellawi, A. Rauda, Scalici, Jennifer, Duska, Linda R, Jazaeri, Amir A, Modesitt, Susan C, Cantrell, Leigh A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2012
• Subjects: Age Factors; Aged; Aged, 80 and over; Complications; Elderly; Female; Frail Elderly; Frailty; Genital Neoplasms, Female - surgery; Geriatric Assessment; Gynecologic Surgical Procedures - adverse effects; Gynecologic Surgical Procedures - statistics & numerical data; Hematology, Oncology and Palliative Medicine; Humans; Obstetrics and Gynecology; Outcome Assessment (Health Care); Ovarian cancer; Pilot Projects; Postoperative Complications - etiology; Predictive Value of Tests; Risk Factors; Frailty; Complications; Elderly; Ovarian cancer
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2012.04.019

Abstract Objectives The objective of this pilot study was to determine if frailty predicts surgical complications among elderly women undergoing gynecologic oncology procedures. Methods A cohort of gynecologic oncology patients age ≥ 65, undergoing surgery between March and December 2011 was identified. Frailty was evaluated using a validated assessment tool. The primary outcome measure was 30 day postoperative complication rate. Results Forty women were approached for study entry and 37 (92%) enrolled. The mean age was 73 years (range 65–95). The majority of women had a malignancy and underwent a major abdominal surgical procedure. Twenty-one women (57%) were not frail, 10 (27%) were intermediately frail and 6 (16%) were frail. There was no difference in age or prevalence of medical comorbidities between groups. Frail women had a significantly higher BMI compared to intermediately frail and not frail women, (36.0, 31.5 and 26.1 kg/m2 , p = 0.02). The rate of 30-day surgical complications increased with frailty score and was 24%, versus 67% for women who were not frail as compared to the frail ( p = 0.04). Conclusions Pre-operative frailty assessment is well accepted by gynecologic oncology patients and feasible in a clinic setting. Frail women had a higher BMI, indicating that low body weight is not a marker for frailty, and had a significantly higher rate of 30-day postoperative complications in this pilot study. Initial findings support the concept of measuring frailty as a possible predictor for postoperative morbidity that will allow for improved patient counseling and decision making.