Modified Frailty Index is Useful in Predicting Non‐home Discharge in Elderly Patients with Gastric Cancer Who Undergo Gastrectomy

Abstract

Background Development of laparoscopic gastrectomy and the Enhanced Recovery After Surgery (ERAS) protocol enable early discharge to home of patients with gastric cancer (GC). However, a significant proportion of patients are still discharged to inpatient facilities after surgery. We aimed to identify predictive factors of non-home discharge in patients with GC who undergo gastrectomy. Methods We enrolled 517 patients with histopathologically confirmed diagnosis of GC who underwent gastrectomy. ResultsThe number of patients with non-home discharge was 23 (4.4%), and non-home discharge was only observed in patients with GC aged C65 years. Patients were divided into the mFI High (C0.272) and mFI Low (\0.272) groups according to the cut-off value determined by ROC analysis. The mFI High classification was significantly more frequent in patients aged C75 years, who underwent either total or proximal partial gastrectomy, who underwent limited lymph node dissection, and with non-home discharge than in patients aged \75 years (p = 0.0002), those who underwent distal partial gastrectomy (p = 0.032), those who underwent standard lymph node dissection (p = 0.036), and those without non-home discharge (p = 0.0071). Multivariate analysis revealed mFI as an independent predictive indicator of non-home discharge, along with postoperative complications and surgical approach, in patients with GC aged C65 years. The frequency of patients with non-home discharge was significantly associated with the number of these three predictive factors in GC patients aged C65 years (p \ 0.0001). Conclusions The combination of mFI, postoperative complications, and surgical approach is useful for predicting non-home discharge in patients aged C65 years who underwent gastrectomy for GC.

Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis

“…Apart from the abovementioned outcomes, frailty, as defined by the Modified Frailty Index, was an independent predictor of non-home discharge ( 26 ) and postoperative pulmonary infection ( 27 ) in elderly patients with gastric cancer who underwent gastrectomy. In patients with gastric cancer above the age of 80 years, frailty independently predicted the recurrence-free survival ( 13 ).…”

Usefulness of the Modified Frailty Index for Predicting Pneumonia Occurrence After Esophagectomy

“…We evaluated preoperative frailty using the mFI and set the cutoff to 0.27 based on previous literature. 15,16 The patients were divided into two groups: the high mFI (≥ 0.27) and low mFI (< 0.27) groups. Then, we retrospectively examined their short-term postoperative outcomes.…”

Framework, component, and implementation of enhanced recovery pathways

“…Moreover, when compared to conventional postoperative management, enhanced recovery interventions in elderly and frail patients are associated with significantly shorter lengths of stay, with no significant increase in complication or readmission rates [ 120 ]. The routine use of frailty scores has been proposed [ 121 ] to allow clinicians to better tailor perioperative care, including: better patient selection for surgery [ 122 ]; identifying those who benefit most from Geriatrician/MDT input [ 123 ]; and more accurate discharge planning [ 124 ].…”