SEARCHCOHORTsurgery, oncology

cohort·surgery, oncology, geriatrics, obstetrics and gynecology, epidemiology·PMC10020300

Frailty assessment tools predict perioperative outcome in elderly patients with endometrial cancer better than age or BMI alone: a retrospective observational cohort study

Journal of Cancer Research and Clinical Oncology · 12 authors, 5 centres

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This retrospective study of 153 women over 60 with endometrial cancer found that preoperative frailty status, assessed by tools like the G8 Score, was a significant predictor of postoperative complications and transfusion rates, while age and BMI were not.

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This retrospective observational cohort study included 153 women aged 60 years or older with endometrial cancer who underwent elective surgery at a university medical center. The study evaluated five preoperative frailty assessment tools: the G8 questionnaire, ECOG performance status, Charlson Comorbidity Index, ASA Physical Status, and Lee-Schonberg index. The central result was that frailty status, particularly as assessed by the G8 Score, ECOG, and CCI, was significantly associated with higher rates of preoperative anemia, perioperative transfusions, and postoperative complications compared to non-frail patients. For example, the postoperative complication rate was 20.7% for G8-frail versus 6.7% for non-frail patients. In contrast, chronological age and BMI alone were not statistically significant predictors of these outcomes.

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cohort

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surgery

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ORIGINAL PAPER

PMC10020300

Frailty assessment tools predict perioperative outcome in elderly patients with endometrial cancer better than age or BMI alone: a retrospective observational cohort study

Journal of Cancer Research and Clinical Oncology

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ABSTRACT

Abstract Objective Five commonly used global health assessment tools have been evaluated to identify and assess the preoperative frailty status and its relationship with perioperative in-hospital complications and transfusion rates in older women with endometrial cancer (EC). Methods Preoperative frailty status was examined by the G8 questionnaire, the Eastern Cooperative Oncology Group performance status, the Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status System, as well as the Lee-Schonberg prognostic index. The main outcome measures were perioperative laboratory values, intraoperative surgical parameters and immediately postoperative complications. Results 153 consecutive women ≥ 60 years with all stages of EC, who received primary elective surgery at the University Medical Center Mainz between 2008 and 2019 were classified with selected global health assessment tools according to their preoperative performance status. In contrast to conventional prognostic parameters like older age and higher BMI, increasing frailty was significantly associated with preoperative anemia and perioperative transfusions ( p < 0.05). Moreover, in patients preoperatively classified as frail significantly more postoperative complications (G8 Score: frail: 20.7% vs. non-frail: 6.7%, p = 0.028; ECOG: frail: 40.9% vs. non-frail: 2.8%, p = 0.002; and CCI: frail: 25.0% vs. non-frail: 7.4%, p = 0.003) and an increased length of hospitalization were recorded. According to propensity score matching, the risk for developing postoperative complications for frail patients was approximately two-fold higher, depending on which global health assessment tool was used. Conclusions Preoperatively assessed frailty significantly predicts post-surgical morbidity rates in contrast to conventionally used single prognostic parameters such as age or BMI. A standardized preoperative assessment of frailty in the routine work-up might be beneficial in older cancer patients before major surgery to include these patients in a prehabilitation program with nutrition counseling and physiotherapy to adequately assess the perioperative risk. Keywords: Frailty, Perioperative, Endometrial cancer, Management, Outcome

CITATION EXPORT

Katharina Anic, Friedrich Flohr, Mona Wanda Schmidt et al.. Frailty assessment tools predict perioperative outcome in elderly patients with endometrial cancer better than age or BMI alone: a retrospective observational cohort study. Journal of Cancer Research and Clinical Oncology. (2022). https://doi.org/10.1007/s00432-022-04038-6

AUTHORS

12 · 5 CENTRES

Katharina Anic, Friedrich Flohr, Mona Wanda Schmidt, Slavomir Krajnak, Roxana Schwab, Marcus Schmidt, Christiane Westphalen, Clemens Eichelsbacher, Christian Ruckes, Walburgis Brenner, Annette Hasenburg, Marco Johannes Battista

1Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
2Department of Geriatric Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
3Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
4Interdisciplinary Center Clinical Trials, University Medical Center Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
5Management of the Scientific Laboratories, University Medical Center of Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany