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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Predictive value of frailty assessment tools in patients undergoing surgery for gastrointestinal cancer: An observational cohort study
Hui-Pin Zhang, Hai-Lin Zhang, Xiao-Min Zhou, Guan-Jie Chen, Qi-Fan Zhou, Jie Tang, Zi-Ye Zhu, Wei Wang
Hui-Pin Zhang, Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222061, Jiangsu Province, China
Hui-Pin Zhang, Wei Wang, Department of Gastrointestinal Surgery, The First People’s Hospital of Changzhou, Changzhou 213000, Jiangsu Province, China
Hai-Lin Zhang, Xiao-Min Zhou, Zi-Ye Zhu, Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222061, Jiangsu Province, China
Guan-Jie Chen, Department of Invasive Technology, Zhongda Hospital Southeast University, Nanjing 210003, Jiangsu Province, China
Qi-Fan Zhou, Jie Tang, Department of Hemopurification Center, Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222061, Jiangsu Province, China
Author contributions: Zhang HP, Zhang HL, and Chen GJ designed the study; Zhang HP and Zhou XM collected data; Zhang HP wrote the manuscript; Zhang HL, Chen GJ, Zhou QF, and Wang W revised the manuscript; Tang J and Zhu ZY analysed the data; and all authors read and approved the final manuscript.
Supported by the Postgraduate Research & Practice Innovation Program of Jiangsu Province, No. SJCX22_1293; and Lianyungang City Aging Health Research Project, No. L202206.
Institutional review board statement: The study was approved by the Ethics Committee of the Affiliated Lianyungang Hospital of Xuzhou Medical University (ethics approval number: KY-20211029001-01).
Informed consent statement: Informed consent was obtained from all participants in this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used or analysed during the current study are available from the corresponding authors on reasonable request.
STROBE statement: The authors have read the STROBE guidelines, and the manuscript was prepared and revised according to the STROBE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hai-Lin Zhang, MM, President, Professor, Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Haizhou District, Lianyungang 222061, Jiangsu Province, China.
luckihailin@163.com
Received: June 12, 2023
Peer-review started: June 12, 2023
First decision: August 26, 2023
Revised: September 9, 2023
Accepted: September 26, 2023
Article in press: September 26, 2023
Published online: November 27, 2023
Processing time: 167 Days and 21 Hours
ARTICLE HIGHLIGHTS
Research background
Few studies have simultaneously compared the predictive value of various frailty assessment tools for the prognosis in patients undergoing gastrointestinal cancer surgery. Therefore, it is difficult to determine which assessment tool is most relevant to the prognosis of this population.
Research motivation
We used three commonly used frailty assessment tools to investigate the status of preoperative frailty and to analyse their predictive value for prognosis in patients undergoing surgery for gastrointestinal cancer.
Research objectives
To investigate the predictive value of different frailty assessment tools for postoperative severe complications and increased hospital costs in patients undergoing surgery for gastrointestinal cancer.
Research methods
A single-centre, observational, prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022. A total of 229 patients aged ≥ 18 years who underwent surgery for gastrointestinal cancer were included in this study. We collected baseline data on the participants and administered three scales to assess frailty: The comprehensive geriatric assessment (CGA), Fried phenotype and FRAIL scale. The outcome measures were postoperative severe complications and increased hospital costs.
Research results
The prevalence of frailty when assessed with the CGA was 65.9%, 47.6% when assessed with the Fried phenotype and 34.9% when assessed with the FRAIL scale. Using the CGA as a reference, kappa coefficients were 0.398 for the Fried phenotype and 0.291 for the FRAIL scale (both P < 0.001). Postoperative severe complications and increased hospital costs were observed in 29 (12.7%) and 57 (24.9%) patients, respectively. Multivariate logistic analysis confirmed that the CGA was independently associated with increased hospital costs (odds ratio = 2.298, 95% confidence interval: 1.044-5.057; P = 0.039). None of the frailty assessment tools were associated with postoperative severe complications.
Research conclusions
The CGA has a significant effect on increased hospital costs for patients undergoing gastrointestinal cancer surgery, and should be included as part of routine preoperative risk assessment in this population.
Research perspectives
More long-term outcome measures (including relapse-free survival time and overall survival) should be of interest. In addition, there is an urgent need for a pre-rehabilitation program which is suitable for China’s national conditions to improve preoperative frailty in patients undergoing gastrointestinal cancer surgery.
