Objectives: We sought to examine the relationship between frailty and complicated postoperative courses, including intensive care unit (ICU) admission and non-home discharge, in patients with advanced ovarian cancer (OC) undergoing primary debulking surgery (PDS) for curative intent.
Methods: Patients were identified from a retrospectively collected database at a single institution between 1/1/2003-12/31/2011. A frailty index was derived from 30 items representing comorbidities and activities of daily living, each scored as 0, 0.5, or 1, and calculated as the total summated score divided by the total number of non-missing items. Frailty was defined as an index ≥0.15. Associations with binary outcomes were assessed using logistic regression.
Results: A total of 535 patients met inclusion criteria. Frail patients were older, mean age 67.8 versus 63.2 years (p < 0.001), but there was no difference in grade, stage, or serous histology. Almost half of the frail patients (48.9%, 64/131) were admitted to the ICU compared to 20.5% (83/404) of non-frail patients. Frailty remained an independent predictor of 30-day ICU admission (adjusted odds ratio (aOR) 3.20, 95% CI: 2.03-5.06) in a multivariable model including age, preoperative albumin, surgical complexity, and residual disease. Frail patients were also more likely to have a non-home discharge (24.2% vs. 7.0%). Frailty independently predicted non-home discharge (aOR 2.58, 95% CI: 1.35-4.93) after adjusting for age, BMI, and stage.
Conclusion: Frailty is a measurable, objective clinical syndrome that has impact on postoperative outcomes in advanced OC and should be considered when decision-making about treatments and counseling patients.
Keywords: Frailty; ICU; Non-home discharge; Ovarian cancer; Surgical outcomes.
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