Abstract
Frailty is a source of morbidity in esophagectomy patients. To aid clinical decision making, it is important to determine if the simplified 5-factor modified frailty index (mFI-5) retains the same associations between frailty and adverse outcomes as its 11-factor predecessor.
Patients undergoing esophagectomy for esophageal cancer or dysplasia from 2016-2018 were identified using National Surgical Quality Improvement Program (NSQIP). The mFI-5 was used to determine association between frailty and post-esophagectomy morbidity and mortality.
In total, 2,567 patients were included. No patients had a mFI-5 score higher than 3/5 and the score distribution was wide: mFI0 = 1103 (43%), mFI1 = 982 (38.3%), mFI2 = 435 (16.9%), mFI3 = 47 (1.8%). Clavien-Dindo grade IV complications increased with mFI score: mFI0 (11.2%), mFI1 (15.6%), mFI2 (19.8%), mFI3 (25.5%), as did mortality: mFI0 (1.9%), mFI1 (3%), mFI2 (3.4%), mFI3 (4.3%). Multivariate logistic regression analyses controlling for age, sex, body mass index, American Society of Anesthesiology classification, operative duration, emergency surgery status, and neoadjuvant therapy status showed increasing frailty score was associated with Clavien-Dindo grade IV complications (p=0.01), but not mortality (p=0.13).
The mFI-5 is associated with morbidity but not mortality in patients who have undergone esophagectomy for esophageal cancer. Compared to the mFI-11, the mFI-5 may not be nuanced enough in the assessment of frailty specific to this patient population.
