A1 Refereed original research article in a scientific journal
The Clinical Frailty Scale is a useful tool for predicting postoperative complications following elective colon cancer surgery at the age of 80 years and above: A prospective, multicentre observational study
Authors: Niemeläinen Susanna, Huhtala Heini, Andersen Jan, Ehrlich Anu, Haukijärvi Eija, Koikkalainen Suvi, Koskensalo Selja, Kössi Jyrki, Mattila Anne, Pinta Tarja, Uotila-Nieminen Mirjami, Vihervaara Hanna, Hyöty Marja, Jämsen Esa
Publisher: WILEY
Publication year: 2021
Journal: Colorectal Disease
Journal name in source: COLORECTAL DISEASE
Journal acronym: COLORECTAL DIS
Volume: 23
Issue: 7
First page : 1824
Last page: 1836
Number of pages: 13
ISSN: 1462-8910
eISSN: 1463-1318
DOI: https://doi.org/10.1111/codi.15689(external)
Aim
Identification of the risks of postoperative complications may be challenging in older patients with heterogeneous physical and cognitive status. The aim of this multicentre, observational study was to identify variables that affect the outcomes of colon cancer surgery and, especially, to find tools to quantify the risks related to surgery.
Method
Patients aged >= 80 years with electively operated Stage I-III colon cancer were recruited. The prospectively collected data included comorbidities, results of the onco-geriatric screening tool (G8), Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI) and Mini Nutritional Assessment-Short Form (MNA-SF), and operative and postoperative outcomes.
Results
A total of 161 patients (mean 84.5 years, range 80-97, 60% female) were included. History of cerebral stroke (64% vs. 37%, p = 0.02), albumin level 31-34 g/l compared with >= 35 g/l (57% vs. 32%, p = 0.007), CFS 3-4 and 5-9 compared with CFS 1-2 (49% and 47% vs. 16%, respectively) and American Society of Anesthesiologists score >3 (77% vs. 28%, P = 0.006) were related to a higher risk of complications. In multivariate logistic regression analysis CFS >= 3 (OR 6.06, 95% CI 1.88-19.5, p = 0.003) and albumin level 31-34 g/l (OR 3.88, 1.61-9.38, p = 0.003) were significantly associated with postoperative complications. Severe complications were more common in patients with chronic obstructive pulmonary disease (43% vs. 13%, p = 0.047), renal failure (25% vs. 12%, p = 0.021), albumin level 31-34 g/l (26% vs. 8%, p = 0.014) and CCI >6 (23% vs. 10%, p = 0.034).
Conclusion
Surgery on physically and cognitively fit aged colon cancer patients with CFS 1-2 can lead to excellent operative outcomes similar to those of younger patients. The CFS could be a useful screening tool for predicting postoperative complications.
