Published online Nov 27, 2023. doi: 10.4240/wjgs.v15.i11.2525
Peer-review started: June 12, 2023
First decision: August 26, 2023
Revised: September 9, 2023
Accepted: September 26, 2023
Article in press: September 26, 2023
Published online: November 27, 2023
Processing time: 167 Days and 21 Hours
Few studies have simultaneously compared the predictive value of various frailty assessment tools for the prognosis in patients undergoing gastrointestinal cancer surgery. Therefore, it is difficult to determine which assessment tool is most relevant to the prognosis of this population.
We used three commonly used frailty assessment tools to investigate the status of preoperative frailty and to analyse their predictive value for prognosis in patients undergoing surgery for gastrointestinal cancer.
To investigate the predictive value of different frailty assessment tools for postoperative severe complications and in
A 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 postoperative severe complications and increased hospital costs.
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.
The CGA has a significant effect on increased hospital costs for patients undergoing gastrointestinal cancer surgery, and should be included as part of routine preoperative risk assessment in this population.
More long-term outcome measures (including relapse-free survival time and overall survival) should be of interest. In addition, there is an urgent need for a pre-rehabilitation program which is suitable for China’s national conditions to improve preoperative frailty in patients undergoing gastrointestinal cancer surgery.