Predictive value of frailty assessment tools in patients undergoing surgery for gastrointestinal cancer: An observational cohort study

Table 1 Baseline patient characteristics

Variables	Comprehensive geriatric assessment			Fried phenotype			FRAIL scale
	Non-frail (n = 78)	Frail (n = 151)	P value	Non-frail (n = 120)	Frail (n = 109)	P value	Non-frail (n = 149)	Frail (n = 80)	P value
Male, n (%)	53 (67.9)	88 (58.3)	0.154	78 (65.0)	63 (57.8)	0.263	96 (64.4)	45 (56.3)	0.225
Age, yr	66 (57-71)	68 (62-76)	0.020	65 (57-71)	70 (63-76)	< 0.001	66 (58-72)	69 (63-76)	0.012
BMI, kg/m2	24.45 ± 3.47	23.33 ± 3.39	0.021	24.35 ± 3.12	23.0 ± 3.68	0.003	23.95 ± 3.27	23.27 ± 3.75	0.158
Smoking history, n (%)	35 (44.9)	71 (47.0)	0.757	62 (51.7)	44 (40.4)	0.087	76 (51.0)	30 (37.5)	0.051
Drinking history, n (%)	32 (41.0)	68 (45.0)	0.562	61 (50.8)	39 (35.8)	0.022	70 (47.0)	30 (37.5)	0.168
Neoadjuvant therapy, n (%)	2 (2.6)	10 (6.6)	0.321	4 (3.3)	8 (7.3)	0.174	5 (3.4)	7 (8.8)	0.151
CCI score, n (%)	78 (100)		0.001			0.091			0.003
0-2	0 (0)	133 (88.1)		114 (95.0)	97 (89.0)		143 (96.0)	68 (85.0)
≥ 3	0 (0)	18 (11.9)		6 (5.0)	12 (11.0)		6 (4.0)	12 (15.0)
Polypharmacy, n (%)		6 (4.0)	0.178	1 (0.8)	5 (4.6)	0.173	0 (0)	6 (7.5)	0.003
Upper arm circumference, cm	29.5 ± 2.5	28.2 ± 2.9	0.001	29.3 ± 2.4	27.8 ± 3.1	< 0.001	29.1 ± 2.6	27.8 ± 3.1	0.001
Waist circumference, cm	89.8 ± 9.8	87.5 ± 9.7	0.091	89 ± 39.4	87.1 ± 10.0	0.099	88.7 ± 9.8	87.3 ± 9.6	0.303
Hip circumference, cm	96.4 ± 6.3	93.6 ± 7.4	0.006	96.0 ± 6.0	92.9 ± 7.9	0.001	95.1 ± 6.7	93.7 ± 7.9	0.157
Calf circumference, cm	34.8 ± 3.2	33.0 ± 3.4	< 0.001	34.8 ± 3.0	32.3 ± 3.5	< 0.001	34.2 ± 3.2	32.5 ± 3.6	0.001
HB, g/L	130 (109-137)	116 (97-133)	0.003	130 (114-141)	108 (92-128)	< 0.001	127 (111-138)	106 (87-128)	< 0.001
WBC, 109/L	5.75 (4.50-6.84)	6.00 (4.70-7.22)	0.184	5.85 (4.52-6.97)	5.93 (4.72-6.90)	0.598	5.80 (4.53-6.81)	6.00 (4.76-7.54)	0.186
Platelet, 1012/L	209 (178-244)	228 (186-270)	0.171	212 (181-249)	228 (186-274)	0.255	219 (179-254)	227 (190-278)	0.265
Lymphocyte count, 109/L	1.56 (1.17-1.97)	1.39 (1.07-1.77)	0.070	1.47 (1.17-1.96)	1.40 (1.04-1.74)	0.046	1.44 (1.16-1.94)	1.40 (0.92-1.74)	0.067
Lymphocyte ratio, %	28.6 (23.0-33.0)	23.5 (18.4-31.3)	0.002	28.2 (21.8-33.3)	23.4 (17.3-29.1)	0.003	27.6 ± 9.2	23.5 ± 9.7	0.013
Creatinine, μmmol/L	63.4 (53.8-71.0)	58.2 (48.5-72.3)	0.127	63.6 (54.4-73.2)	55.3 (47.0-67.5)	0.001	62.5 (52.6-72.5)	56.7 (47.3-69.5)	0.074
Haematocrit, %	39.3 (34.1-41.9)	35.4 (31.3-40.5)	0.003	39.3 (34.9-42.8)	33.5 (29.4-39.0)	< 0.001	38.8 (34.1-41.5)	32.7 (28.0-39.1)	< 0.001
Albumin, g/L	38. ± 13.7	36.4 ± 4.0	0.002	38.4 ± 3.5	35.4 ± 3.9	< 0.001	37.8 ± 3.7	35.4 ± 4.0	< 0.001
Total protein, g/L	62.7 ± 5.8	61.2 ± 5.9	0.059	62.8 ± 5.6	60.5 ± 6.0	0.003	62.4 ± 5.4	60.4 ± 6.6	0.011
ASA classification, n (%)			0.036			0.009			0.011
I-II	55 (70.5)	85 (56.3)		83 (69.2)	57 (52.3)		100 (67.1)	40 (50.0)
III-IV	23 (29.5)	66 (43.7)		37 (30.8)	52 (47.7)		49 (32.9)	40 (50.0)
KPS score, n (%)			< 0.001			< 0.001			< 0.001
≥ 70	76 (97.4)	118 (78.1)		119 (99.2)	75 (68.8)		144 (96.6)	50 (62.5)
< 70	2 (2.6)	33 (21.9)		1 (0.8)	34 (31.2)		5 (3.4)	30 (37.5)
Cancer type, n (%)			0.011			0.216			0.104
Stomach	18 (23.1)	65 (43.0)		40 (33.3)	43 (39.4)		49 (32.9)	34 (42.5)
Colon	32 (41.0)	49 (32.5)		40 (33.3)	41 (37.6)		51 (34.2)	30 (37.5)
Rectum	28 (35.9)	37 (24.5)		40 (33.3)	25 (22.9)		49 (32.9)	16 (20.0)
Operative method, n (%)			0.005			0.008			0.187
Open surgery	13 (16.7)	52 (34.4)		25 (20.8)	40 (36.7)		38 (25.5)	27 (33.8)
Laparoscopic surgery	65 (83.3)	99 (65.6)		95 (79.2)	69 (63.3)		111 (74.5)	53 (66.3)
Operative time, min	156 (123-202)	169 (120-210)	0.578	165 (120-217)	163 (121-195)	0.486	165 (125-210)	160 (119-200)	0.412
TNM stage, n (%)			0.057			0.328			0.911
I-II	55 (70.5)	87 (57.6)		78 (65.0)	64 (58.7)		92 (61.7)	50 (62.5)
III	23 (29.5)	64 (42.4)		42 (35.0)	45 (41.3)		57 (38.3)	30 (37.5)
Histological grade, n (%)			0.012			0.545			0.374
Poorly differentiated	28 (35.9)	78 (51.7)		55 (45.8)	51 (46.8)		67 (45.0)	39 (48.8)
Moderately differentiated	33 (42.3)	55 (36.4)		43 (35.8)	45 (41.3)		56 (37.6)	32 (40.0)
Highly differentiated	17 (21.8)	18 (11.9)		22 (18.3)	13 (11.9)		26 (17.4)	9 (11.3)
Postoperative length of stay, d	14 (12, 16)	14 (12, 19)	0.184	14 (12, 18)	15 (13, 18)	0.162	14 (12, 17)	15 (13, 19)	0.029
Hospital costs, RMB	62341 (58067, 71180)	67697 (59097, 81720)	0.006	63148 (57893, 74841)	67764 (59156, 82804)	0.047	63477 (57719, 76170)	69031 (59596, 82043)	0.023
Severe complications, n (%)	6 (7.7)	23 (15.2)	0.104	13 (10.8)	16 (14.7)	0.382	16 (10.7)	13 (16.3)	0.232

Data are presented as means ± SD, medians (interquartile ranges) or n (%).

CCI: Charlson Comorbidity Index; BMI: Body mass index; HB: Haemoglobin; WBC: White blood cell; ASA: American Society of Anesthesiologists; KPS: Karnofsky Performance Scale; TNM: Tumour node metastasis.

Table 2 Predictors of severe complications and increased hospital costs (univariate analysis)

Variables	Severe complications (-) (n = 200)	Severe complications (+) (n = 29)	P value	OR (95%CI)	P value	increased hospital costs (-) (n = 172)	increased hospital costs (+) (n = 57)	P value	OR (95%CI)	P value
Male, n (%)	119 (59.5)	22 (79.5)	0.090	0.467 (0.191, 1.145)	0.096	101 (58.7)	40 (70.2)	0.123	0.605 (0.318, 1.151)	0.125
Age, yr	66 (58-73)	70 (65-77)	0.004	1.070 (1.022, 1.120)	0.004	67 (58, 73)	68 (64, 74)	0.212	1.024 (0.993, 1.056)	0.124
BMI, kg/m2	23.52 (21.22-25.72)	23.73 (21.22-26.64)	0.588	1.024 (0.916, 1.146)	0.671	23.52 (21.28, 25.53)	23.59 (20.83, 26.30)	0.876	0.993 (0.911, 1.084)	0.883
Smoking history, n (%)	87 (43.5)	19 (65.5)	0.026	2.468 (1.092, 5.576)	0.030	73 (42.4)	33 (57.9)	0.043	1.865 (1.017, 3.420)	0.044
Drinking history, n (%)	81 (40.5)	19 (65.5)	0.011	2.791 (1.234, 6.313)	0.014	70 (40.7)	30 (52.6)	0.115	1.619 (0.886, 2.957)	0.117
Neoadjuvant therapy, n (%)	12 (6.0)	0 (0)	0.363	NA1		5 (2.9)	7 (12.3)	0.016	4.676 (1.422, 15.376)	0.011
CCI score, n (%)
0-2	184 (92.0)	27 (93.1)	1.000	0.852 (0.185, 3.912)	0.837	158 (91.9)	53 (93.0)	1.000	0.852 (0.269, 2.701)	0.785
≥ 3	16 (8.0)	2 (6.9)	1.000	1.393 (0.157, 12.362)	0.766	14 (8.1)	4 (7.0)	0.336	3.130 (0.614, 15.963)	0.170
Polypharmacy, n (%)	5 (2.5)	1 (3.4)				3 (1.7)	3 (5.3)
Upper arm circumference, cm	28.7 ± 2.8	28.3 ± 3.3	0.453	0.949 (0.827, 1.088)	0.452	28.6 ± 2.8	28.8 ± 2.9	0.633	1.026 (0.923, 1.140)	0.632
Waist circumference, cm	87.9 ± 9.4	90.3 ± 11.9	0.318	1.025 (0.985, 1.067)	0.226	87.6 ± 9.7	90.1 ± 9.7	0.094	1.027 (0.995, 1.059)	0.095
Hip circumference, cm	94.0 (90.7-98.8)	96.0 (89.5-101.3)	0.454	0.998 (0.945, 1.054)	0.938	94.5 ± 7.0	94.9 ± 7.6	0.663	1.009 (0.968, 1.053)	0.661
Calf circumference, cm	33.8 (31.5-35.9)	34.6 (31.8-37.5)	0.719	0.989 (0.883, 1.107)	0.843	33.6 ± 3.4	33.7 ± 3.5	0.768	1.013 (0.928, 1.106)	0.766
HB, g/L	121 (103-135)	119 (100-135)	0.872	0.998 (0.982, 1.015)	0.836	124 (104, 135)	112 (97, 134)	0.208	0.992 (0.979, 1.005)	0.206
WBC, 109/L	5.91 (4.71-6.99)	5.93 (4.20-6.68)	0.441	0.952 (0.782, 1.158)	0.621	5.85 (4.52, 7.03)	5.96 (5.14, 6.85)	0.557	1.008 (0.874, 1.162)	0.917
Platelet, 1012/L	221 (182-263)	204 (168-247)	0.279	0.996 (0.990, 1.001)	0.147	220 (183, 260)	227 (168, 270)	0.809	0.999 (0.995, 1.003)	0.652
Lymphocyte count, 109/L	1.47 (1.16-1.88)	1.22 (1.03-1.77)	0.057	0.483 (0.218, 1.067)	0.072	1.42 (1.10, 1.84)	1.46 (1.20, 1.87)	0.509	1.043 (0.620, 1.756)	0.873
Lymphocyte ratio, %	26.4 ± 9.5	24.0 ± 9.8	0.198	0.972 (0.931, 1.015)	0.198	25.3 (20.4, 32.5)	23.6 (18.6, 31.3)	0.581	0.999 (0.968, 1.031)	0.962
Creatinine, μmmol/L	59.8 (49.8-71.4)	65.7 (55.1-71.3)	0.244	1.008 (0.992, 1.023)	0.342	59.8 (50.5, 71.4)	61.1 (49.9, 71.0)	0.896	0.993 (0.977, 1.010)	0.408
Haematocrit, %	37.2 (32.1-41.0)	35.9 (30.3-41.5)	0.981	0.994 (0.935, 1.058)	0.859	37.8 (32.5, 41.1)	35.0 (31.2, 41.1)	0.294	0.973 (0.928, 1.021)	0.262
Albumin, g/L	37.3 ± 3.9	34.9 ± 4.1	0.002	0.856 (0.772, 0.948)	0.003	37.2 ± 3.8	36.4 ± 4.3	0.236	0.955 (0.885, 1.030)	0.236
Total protein, g/L	61.8 (58.3-65.8)	58.9 (56.6-62.4)	0.012	0.921 (0.857, 0.989)	0.023	61.6 (58.0, 65.3)	60.5 (57.6, 64.7)	0.977	1.015 (0.965, 1.068)	0.567
ASA classification, n (%)
I-II	127 (63.5)	13 (44.8)	0.054	2.141 (0.975, 4.701)	0.058	112 (65.1)	28 (49.1)	0.032	1.933 (1.054, 3.546)	0.033
III-IV	73 (36.5)	16 (55.2)				60 (34.9)	29 (50.9)
KPS score, n (%)
≥ 70	170 (85.0)	24 (82.8)	0.970	1.181 (0.418, 3.336)	0.754	150 (87.2)	44 (77.2)	0.069	2.014 (0.939, 4.323)	0.072
< 70	30 (15.0)	5 (17.2)				22 (12.8)	13 (22.8)
Cancer type, n (%)
Stomach	74 (37.0)	9 (31.0)	0.743	Reference		56 (32.6)	27 (47.4)	0.114	Reference
Colon	69 (34.5)	12 (41.4)		1.430 (0.567, 3.604)	0.448	63 (36.6)	18 (31.6)		0.593 (0.295, 1.189)	0.141
Rectum	57 (28.5)	8 (27.6)		1.154 (0.419, 3.178)	0.782	53 (30.8)	12 (21.1)		0.470 (0.216, 1.021)	0.057
Operative method, n (%)
Open surgery	58 (29.0)	7 (24.1)	0.587	1.284 (0.520, 3.169)	0.588	52 (30.2)	13 (22.8)	0.281	1.467 (0.729, 2.951)	0.283
Laparoscopic surgery	142 (71.0)	22 (75.9)				120 (69.8)	44 (77.2)
Operative time, min	159 (120-202)	180 (135-225)	0.097	1.006 (1.000, 1.012)	0.053	157 (120, 196)	170 (131, 220)	0.157	1.004 (0.999, 1.009)	0.112
TNM stage, n (%)
I-II	124 (62.0)	18 (62.1)	0.994	0.997 (0.447, 2.225)	0.994	111 (64.5)	31 (54.4)	0.171	1.526 (0.831, 2.802)	0.173
III	76 (38.0)	11 (37.9)				61 (35.5)	26 (45.6)
Histological grade, n (%)
Poorly differentiated	91 (45.5)	15 (51.7)	0.322	0.725 (0.408, 1.287)	0.272	74 (43.0)	32 (56.1)	0.073	0.674 (0.434, 1.048)	0.080
Moderately differentiated	76 (38.0)	12 (41.4)				69 (40.1)	19 (33.3)
Highly differentiated	33 (16.5)	2 (6.9)				29 (16.9)	6 (10.5)
Severe complications, n (%)	-	-	-	-	-	14 (8.1)	15 (26.3)	< 0.001	4.031 (1.804, 9.005)	0.001
Postoperative length of stay, d	-	-	-	-	-	14 (12, 16)	17 (14, 24)	< 0.001	1.160 (1.094, 1.229)	< 0.001

¹NA: Low number of observations.

Data are presented as means ± SD, medians (interquartile ranges) or n (%). CCI: Charlson Comorbidity Index; BMI: Body mass index; HB: Haemoglobin; WBC: White blood cell; ASA: American Society of Anesthesiologists; KPS: Karnofsky Performance Scale; TNM: Tumour node metastasis; OR: Odds ratio; CI: Confidence interval.

Table 3 Impact of frailty on severe complications and increased hospital costs by the multivariate logistic regression

	Frail group	Non-frail group	Univariate		Multivariate
			Frailty: OR (95%CI)	P value	Frailty: OR (95%CI)	P value	Other significant predictors, OR (95%CI), P value
Severe complications
Comprehensive geriatric assessment, N = 151, n = 78	23 (15.2)	6 (7.7)	2.156 (0.839, 5.541)	0.111	-	-	Age: 1.064 (1.010, 1.122); P = 0.019. Drinking history: 3.649 (1.504, 8.855); P = 0.004. Albumin: 0.880 (0.783, 0.989); P = 0.032. Operative time: 1.008 (1.001, 1.015); P = 0.022
Fried phenotype, N = 109, n = 120	16 (14.7)	13 (10.8)	1.416 (0.647, 3.098)	0.384	-	-	Age: 1.064 (1.010, 1.122); P = 0.019. Drinking history: 3.649 (1.504, 8.855); P = 0.004. Albumin: 0.880 (0.783, 0.989); P = 0.032. Operative time: 1.008 (1.001, 1.015); P = 0.022
FRAIL scale, N = 80, n = 149	13 (16.3)	16 (10.7)	1.112 (0.866, 1.428)	0.406	-	-	Age: 1.064 (1.010, 1.122); P = 0.019. Drinking history: 3.649 (1.504, 8.855); P = 0.004. Albumin: 0.880 (0.783, 0.989); P = 0.032. Operative time: 1.008 (1.001, 1.015); P = 0.022
Increased hospital costs
Comprehensive geriatric assessment, N = 151, n = 78	46 (30.5)	11 (14.1)	2.668 (1.291, 5.513)	0.008	2.298 (1.044, 5.057)	0.039	Postoperative length of stay: 1.167 (1.098, 1.241); P < 0.001. Neoadjuvant therapy: 5.778 (1.601, 20.860); P = 0.007
Fried phenotype, N = 109, n = 120	33 (30.3)	24 (20.0)	1.737 (0.948, 3.183)	0.074	-	-	Postoperative length of stay: 1.168 (1.100, 1.241); P < 0.001. Neoadjuvant therapy: 6.348 (1.792, 22.484); P = 0.004
FRAIL scale, N = 80, n = 149	25 (31.3)	32 (21.5)	1.662 (0.900, 3.069)	0.105	-	-	Postoperative length of stay: 1.168 (1.100, 1.241); P < 0.001. Neoadjuvant therapy: 6.348 (1.792, 22.484); P = 0.004

N: Number in frailty group; n: Number in non-frailty group; OR: Odds ratio; CI: Confidence interval.