FRAIL scale as a predictor of complications and mortality in older patients undergoing reconstructive surgery for non‑melanoma skin cancer

Valdatta, Luigi; Perletti, Gianpaolo; Maggiulli, Francesca; Tamborini, Federico; Pellegatta, Igor; Cherubino, Mario

doi:10.3892/ol.2018.9568

Cited by 15 publications

(29 citation statements)

References 30 publications

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“…As far as we know, frailty has never been examined in a cohort undergoing surgery for cutaneous malignancies. Valdatta et al investigated the FRAIL index in a cohort undergoing reconstructive surgery after NMSC excision [47]. A higher score on the FRAIL index was associated with more moderate to severe complications.…”

Section: Discussionmentioning

confidence: 99%

Geriatric assessment of patients treated for cutaneous head and neck malignancies in a tertiary referral center: Predictors of postoperative complications

Vries

Heirman

Bras

et al. 2020

European Journal of Surgical Oncology

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a b s t r a c tIntroduction: As cutaneous head and neck malignancies are highly prevalent especially in older patients, the risk of surgical complications is substantial in this potentially vulnerable population. The objective of this study was to evaluate the value of geriatric assessment of this population with respect to postoperative complications. Methods: Patients were prospectively included in OncoLifeS, a databiobank. Before surgery, patients underwent a geriatric assessment including multiple validated screening tools for frailty, comorbidity, polypharmacy, nutrition, functional status, social support, cognition and psychological status. Postoperatively, complications (Clavien-Dindo grade II) were registered. Uni-and multivariable logistic regression analyses were performed yielding odds ratios (ORs) and 95% confidence intervals (95%CIs). Results: 151 patients undergoing surgery for cutaneous head and neck malignancies were included in this study (mean age 78.9 years, 73.5% male). In a multivariable analysis, frailty measured by the Geriatric 8 (G8) (OR ¼ 6.34; 95%CI:1.73e23.25) was the strongest independent predictor of postoperative complications, among other predictors such as major treatment intensity (OR ¼ 2.73; 95%CI:1.19e6.26) and general anesthesia (OR ¼ 4.74; 95%CI:1.02e22.17), adjusted for age and sex. Conclusion: Frailty, measured by G8, is the strongest predictor of postoperative complications in patients undergoing surgery for cutaneous head and neck malignancies in addition to treatment intensity and type of anesthesia. Geriatric screening on multiple domains is recommended for patients with cutaneous malignancies undergoing head and neck surgery is recommended, as this population includes old patients and frequently suffers postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Geriatric assessment of patients treated for cutaneous head and neck malignancies in a tertiary referral center: Predictors of postoperative complications

Vries

Heirman

Bras

et al. 2020

European Journal of Surgical Oncology

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“…Hence, we designed a prospective study wherein older patients scheduled for elective spine surgery were screened preoperatively for frailty with the FRAIL (measuring fatigue, resistance, ambulation, illness, and weight loss) scale, a validated five-item questionnaire for predicting decline in health or mortality, and cognition with the Mini-Cog and Animal Verbal Fluency tests, which we and others have previously demonstrated can stratify older surgical patients at risk of postoperative delirium and other adverse outcomes. 8,10,11,[15][16][17] Our secondary aims were exploratory in nature and investigate associations between perioperative variables, including frailty and cognitive performance, with all in-hospital complications, discharge to place other than home and hospital length of stay.…”

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery

Susano¹,

Grasfield²,

Friese³

et al. 2020

Anesthesiology

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Background Frailty and cognitive impairment are associated with postoperative delirium, but are rarely assessed preoperatively. The study was designed to test the hypothesis that preoperative screening for frailty or cognitive impairment identifies patients at risk for postoperative delirium (primary outcome). Methods In this prospective cohort study, the authors administered frailty and cognitive screening instruments to 229 patients greater than or equal to 70 yr old presenting for elective spine surgery. Screening for frailty (five-item FRAIL scale [measuring fatigue, resistance, ambulation, illness, and weight loss]) and cognition (Mini-Cog, Animal Verbal Fluency) were performed at the time of the preoperative evaluation. Demographic data, perioperative variables, and postoperative outcomes were gathered. Delirium was the primary outcome detected by either the Confusion Assessment Method, assessed daily from postoperative day 1 to 3 or until discharge, if patient was discharged sooner, or comprehensive chart review. Secondary outcomes were all other-cause complications, discharge not to home, and hospital length of stay. Results The cohort was 75 [73 to 79 yr] years of age, 124 of 219 (57%) were male. Many scored positive for prefrailty (117 of 218; 54%), frailty (53 of 218; 24%), and cognitive impairment (50 to 82 of 219; 23 to 37%). Fifty-five patients (25%) developed delirium postoperatively. On multivariable analysis, frailty (scores 3 to 5 [odds ratio, 6.6; 95% CI, 1.96 to 21.9; P = 0.002]) versus robust (score 0) on the FRAIL scale, lower animal fluency scores (odds ratio, 1.08; 95% CI, 1.01 to 1.51; P = 0.036) for each point decrease in the number of animals named, and more invasive surgical procedures (odds ratio, 2.69; 95% CI, 1.31 to 5.50; P = 0.007) versus less invasive procedures were associated with postoperative delirium. Conclusions Screening for frailty and cognitive impairment preoperatively using the FRAIL scale and the Animal Verbal Fluency test in older elective spine surgery patients identifies those at high risk for the development of postoperative delirium. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…Frailty was associated with a non‐significant lower overall survival rate and no significant differences in complication rates between frail patients and robust patients were seen in this relatively small population with heterogeneous underlying diseases 70 . Valdatta et al ., 71 however, did find a higher complication and mortality rate in frail patients undergoing reconstructive surgery after non‐melanoma skin cancer surgery. These studies used various instruments to detect frailty, frequently based on those frailty‐related aspects that were fortuitously available from retrospectively extracted clinical data, which highly limits comparison and generalizability.…”

Section: Discussionmentioning

confidence: 68%

Frailty screening in dermato‐oncology practice: a modified Delphi study and a systematic review of the literature

Winden

Garcovich

Peris

et al. 2020

Acad Dermatol Venereol

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Background Appropriate management and prevention of both under-and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato-oncology care, since frailty is associated with adverse health outcomes. Objectives This study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato-oncology practice and to select the best existing FST(s) for this purpose. Methods A modified two-round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5-point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure. Results Consensus was achieved on evaluation of comorbidities (4.3 AE 0.7), polypharmacy (4.0 AE 0.9) and cognition (4.1 AE 0.8). The FST should have appropriate measurement properties (4.0 AE 1.0), be quickly executed (4.2 AE 0.7), clinically relevant (4.3 AE 0.7), and both easily understandable (4.1 AE 1.2) and interpretable (4.3 AE 0.7). Of the 26 identified FSTs, four evaluated the content-related domains: the Geriatric-8 (G8), the modified Geriatric-8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool. Of these, the G8 was the most extensively studied FST, with the best psychometric properties and execution within 5 min. Conclusions The G8 appears the most suitable FST for assessing frailty in older adults with skin cancer, although clinical studies assessing its use in a dermato-oncology population are needed to further assess whether or not frailty in this particular patient group is associated with relevant outcomes (e.g. complications and mortality), as seen in previous studies in other medical fields.

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FRAIL scale as a predictor of complications and mortality in older patients undergoing reconstructive surgery for non‑melanoma skin cancer

Cited by 15 publications

References 30 publications

Geriatric assessment of patients treated for cutaneous head and neck malignancies in a tertiary referral center: Predictors of postoperative complications

Geriatric assessment of patients treated for cutaneous head and neck malignancies in a tertiary referral center: Predictors of postoperative complications

Brief Preoperative Screening for Frailty and Cognitive Impairment Predicts Delirium after Spine Surgery

Frailty screening in dermato‐oncology practice: a modified Delphi study and a systematic review of the literature

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