Preoperative assessment of frailty predicts age‐related events after hepatic resection: a prospective multicenter study

Tanaka, Shogo; Ueno, Masaki; Iida, Hiroya; Kaibori, Masaki; Nomi, Takeo; Hirokawa, Fumitoshi; Ikoma, Hisashi; Nakai, Toshiko; Eguchi, Hidetoshi; Kubo, Shoji

doi:10.1002/jhbp.568

Cited by 54 publications

(65 citation statements)

References 35 publications

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“…Based on their multivariate analysis, frailty was found to be an independent risk factor of age-related events after liver resection, including major cardiopulmonary complications, delirium requiring medical treatment, transfer to a rehabilitation facility, and dependency. However, the incidence of overall and major complications, 30-day mortality, and LOS did not differ between frail and non-frail patients, while the 90-day mortality rate was significantly higher in the frailty group [64] . Details of the studies utilizing frailty assessment tools to evaluate postoperative outcomes after liver resection are summarized in Table 2 [72] .…”

Section: Liver Resection and Frailtymentioning

confidence: 73%

“…Data have shown that CFS can reliably distinguish patients who are going to have a complicated course and prolonged LOS while in the acute medical ward [63] . A screening tool for frailty broadly used in Japan is the Kihon Checklist (KCL) [64] . KCL is a self-reporting "yes/no" survey that can help clinicians assess the status of older individuals in several frailty domains (functional, physical, psychological, and social) [65] .…”

Section: Frailty Assessment Toolsmentioning

confidence: 99%

“…Nonetheless, mortality rates were 0% in both study groups. A prospective multicenter study from Japan sought to evaluate the impact of frailty, as measured by the KCL, on age-related morbidity after hepatic resection [64] . According to this phenotypic FI, patients are deemed frail when KCL is 8 or higher.…”

Section: Liver Resection and Frailtymentioning

confidence: 99%

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Frailty and Liver resection: where do we stand?

Sioutas¹,

Ziogas²,

Tsoulfas³

2020

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As the world population is continuously aging, the number of older patients requiring liver surgery is also on the rise. Data have shown that age should not be a limiting factor for liver resection, as it cannot accurately predict postoperative outcomes. Instead, frailty can serve as a more reliable measure of the patient's overall health and functional reserves. Several frailty assessment tools have been implemented for preoperative risk stratification before liver surgery, and higher scores have commonly been associated with postoperative morbidity, mortality, and length of hospital stay. However, no consensus has been reached on the most useful screening tool. Future studies should focus on comparing the currently available assessment tools, constructing a liver resection-specific tool, and assessing the role of frailty assessment tools in preoperative patient optimization.

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Section: Liver Resection and Frailtymentioning

confidence: 73%

Section: Frailty Assessment Toolsmentioning

confidence: 99%

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Frailty and Liver resection: where do we stand?

Sioutas¹,

Ziogas²,

Tsoulfas³

2020

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“…A promising factor that also influences post-operative outcomes is patient frailty, defined as a syndrome characterized by decreased physiological reserves. Only one study has reported a specific association between frailty and PHLF [16] . However, frailty assessment is based on a self-reporting questionnaire, which could be affected by several biases.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive tests for the prediction of post-hepatectomy liver failure in the elderly

Marasco¹,

Colecchia²,

Milandri³

et al. 2020

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Post-hepatectomy liver failure (PHLF) is associated with great morbidity and mortality after resection of hepatocellular carcinoma. Previous studies have underlined that advanced age could be a potential factor influencing post-operative complications and long-term survival. In the past, candidates for resection were based on the Child-Pugh classification, the predictive value of which was rather low. The selection of patients undergoing resection in Western countries is based on the assessment of portal hypertension (PH), which is clinically assessed by measurement of the hepatic venous pressure gradient, an invasive and costly process. Thus, there have been several attempts to identify the best non-invasive test (NIT) to accurately predict PHLF. Most biochemical NITs for the prediction of PHLF are focused on evaluation of underlying liver cirrhosis and PH. Amongst them, FIB-4, which also includes the patient's age, seems to have more robust supporting results. In Europe and the USA., the most tested and reliable NIT for predicting PHLF is the evaluation of liver stiffness measurement, which is also influenced by age. Imaging parameters are promising tools which are used only in specialized centers however, and when available. Liver volume parameters, as well as contrastenhanced data, demonstrate good accuracy in predicting PHLF. In this scenario, the evaluation of sarcopenia and bone mineral density through contextual imaging allows the delineation of PHLF in at-risk elderly patients. Further studies focused on parameters for the evaluation of PHLF in elderly patients are needed.

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“…Patient prognosis after hepatectomy is in uenced by patient age, general status, co-morbidity or organ functional reserve as well. The relationship with these parameters have been also recently examined (4)(5)(6) and, however, unexpected postoperative morbidity as hepatic failure and related mortality were still observed at this stage.…”

Section: Introductionmentioning

confidence: 99%

Does Risk Calculator by Nationwide Survey Match The Postoperative Outcome in Patients Who Underwent Major Hepatectomy?

Nanashima

Imamura

Hiyoshi

et al. 2020

Preprint

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Background: To clarify significance of the present National Clinical Database risk calculator (NCD-RC) for hepatectomy in Japan, relationship between perioperative parameters or outcomes in major hepatectomy and the mortality rate by NCD-RC was examined. Methods: Patient demographics, co-morbidity, surgical records, postoperative morbidity or mortality were examined and compared to the 30 days- or in-hospital-mortality rate among 55 patients with hepatobiliary diseases who underwent hemi- or more-extended hepatectomy and central (segment 458) hepatectomy. The cut-off percent for high risk mortality before hepatectomy was set at 5% in this period. Results: In-hospital morbidity over CD III was 17 (28%), The 30-day mortality and in-hospital mortality was nil and two (3%), respectively. Male patient showed significantly higher in-hospital mortality rate (p<0.01). In the 37 patients (group woML), mean age was 67.8±8.7 years old ranging 45 and 84. Others included A) with severe complications or mortality in whom low mortality rate (group wML, n=13), B) without severe complications neither mortality in whom high mortality rate (group woMH, n=7), and C) with severe complications or mortality in whom high mortality rate (group wMH, n=4 (6.5%)). Age, distribution of elderly patients, gender, the hepatobiliary diseases and the prevalence of preoperative co-morbidity were not significantly different between groups. In the group wML, the bile leakage was dominant and, however, the in-hospital death was not observed. In the group wMH, all operations were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy and two died of hepatic failure and, however, the prevalence of RH-BDR was not significantly higher in comparison with other groups. Conclusions: Predictive mortality rate by risk calculator under nationwide survey did not always match with patient outcomes in the actual clinical setting and further improvement will be required. In case of RH-BDR for biliary malignancy with high predictive rate, the careful perioperative managements is important under the present nationwide database.

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Preoperative assessment of frailty predicts age‐related events after hepatic resection: a prospective multicenter study

Abstract: Frailty evaluated by KCL in the elderly can predict postoperative age-related events after hepatic resection.

Cited by 54 publications

References 35 publications

Frailty and Liver resection: where do we stand?

Frailty and Liver resection: where do we stand?

Non-invasive tests for the prediction of post-hepatectomy liver failure in the elderly

Does Risk Calculator by Nationwide Survey Match The Postoperative Outcome in Patients Who Underwent Major Hepatectomy?

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