Modified frailty index predicts postoperative complications in women with gynecologic cancer undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Gynecol Oncol. 2021 Aug;162(2):368-374. doi: 10.1016/j.ygyno.2021.05.013. Epub 2021 May 31.

Abstract

Objective(s): To evaluate the impact of frailty on postoperative complications following cytoreductive surgery (CRS) with hyperthermic intra-peritoneal chemotherapy (HIPEC) in women with advanced or recurrent gynecologic cancer.

Methods: An IRB-approved single-institution prospective registry was queried for women who underwent CRS with HIPEC for advanced or recurrent gynecologic cancer from 1/1/2014-12/31/2020. Frailty was defined as a modified Frailty Index (mFI) score of ≥2. Logistic regression was used to assess the impact of mFI upon the rate of moderate or higher (≥ grade 2) Accordion postoperative complications.

Results: Of 141 women, 81.6% (n = 115) were non-frail with mFI of 0-1 and 18.4% (n = 26) were frail with mFI ≥2. The incidence of ≥ grade 2 complications was 21.2% (n = 14) for mFI = 0, 26.5% (n = 13) for mFI = 1, 64.7% (n = 11) for mFI = 2 and 100.0% (n = 9) for patients with mFI ≥3. The incidence of re-operation (1.7% vs. 11.5%, p = 0.044), ICU admission (13.2% vs. 34.6%, p = 0.018), acute kidney injury (6.3% vs. 30.8%, p = 0.001), and respiratory failure (0.9% vs. 19.2%, p < 0.001) were significantly lower amongst non-frail vs. frail women. On multivariable analysis, mFI ≥2 was associated with significantly increased ≥ grade 2 complications versus mFI of 0-1 (OR 9.4, 95% CI 3.3, 26.4, p < 0.001). Age (OR 1.04, 95% CI 1.00, 1.09, p = 0.07), surgical indication (recurrent vs. primary) (OR 0.71, 95% CI 0.30, 1.7, p = 0.44) and Surgical Complexity Score of Intermediate or High vs. Low (OR 1.5, 95% CI 0.67, 3.5, p = 0.31) were not associated with ≥grade 2 complications.

Conclusions: Frailty, defined by the modified frailty index, is predictive of ≥grade 2 postoperative complications following CRS with HIPEC in women with gynecologic cancer. Frailty screening before CRS with HIPEC may assist patient selection and improve postoperative outcomes.

Keywords: Frailty; Hyperthermic intra-peritoneal chemotherapy; Modified frailty index; Ovarian cancer; Perioperative outcomes; Surgery.

MeSH terms

  • Aged
  • Clinical Decision-Making / methods
  • Cytoreduction Surgical Procedures / adverse effects*
  • Feasibility Studies
  • Female
  • Frailty / diagnosis*
  • Frailty / etiology
  • Genital Neoplasms, Female / complications
  • Genital Neoplasms, Female / diagnosis
  • Genital Neoplasms, Female / therapy*
  • Humans
  • Hyperthermic Intraperitoneal Chemotherapy / adverse effects*
  • Middle Aged
  • Neoplasm Recurrence, Local / complications
  • Neoplasm Recurrence, Local / diagnosis
  • Neoplasm Recurrence, Local / therapy*
  • Neoplasm Staging
  • Patient Selection
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Assessment / statistics & numerical data
  • Severity of Illness Index