Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery

Table 1 Complies all studies evaluated in patients undergoing esophageal or gastric resection

Ref.	Country	Quality score1	Study design	Sample size	Age (yr)	Male sex (%)	Surgery type	Parameter used to define frailty	Postoperative complication rate	Follow-up (mo)	30-d morbidity (%)	30-d mortality (%)	1-yr OS (%)	5-yr OS (%)	Outcome parameter	Frailty/OS (OR)
Hodari et al[34]	United States	5	R	2095	NR	NR	Esophagectomy	Modified Canadian age index	17.8	NR	NR	NR	96	NR	Postoperative complications	OR = 31.84, P = 0.015
Sheetz et al[35]	United States	7	R	230	62	88	Transhiatal esophagectomy	Lean psoas area (L4 level)	57.8	12.8	NR	NR	11	0	Overall survival	OR = 0.456; 95%CI: 0.197-1.054; P = 0.067
Yip et al[26]	United Kingdom	5	P	36	63	86	Neoadjuvant chemotherapy and esophagectomy	Body composition	26	30	26	0	NR	NR	No multivariate outcome analysis	NR - significant increase in complications and decrease in survival
Awad et al[27]	United Kingdom	7	P	47	63		Esophagectomy gastrectomy	Body composition	NR	24	NR	2.2	23.9	19	No multivariate outcome analysis	NR - significant increase in complications with frailty
Tegels et al[49]	The Netherlands	5	R/P		70	59	Gastrectomy	Groningen frailty index	28	6	NR	9.1	NR	NR	30-d mortality	3.96 (95%CI: 1.12-14.09, P = 0.03)

¹According to the Newcastle-Ottawa Scale ranging from 1 to 9 stars. Age and OS are presented as median values unless indicated otherwise. NR: Not reported; OS: Overall survival; OR: Odds ratio; P: Prospective trial; P/R: Retrospective analysis on prospectively collected data; R: Retrospective trial.

Table 2 Complies the characteristics of all studies evaluated in patients undergoing colorectal resections

Ref.	Country	Quality score1	Study design	Sample size	Age (yr)	Male sex (%)	Surgery type	Parameter used to define frailty	Postoperative complication rate	Follow-up (mo)	30-d morbidity (%)	30-d mortality (%)	1-yr OS (%)	5-yr OS (%)	Outcome parameter	Frailty/outcome (OR)
Rønning et al[67]	New Zealand	6	P	84	82	41	Colorectal surgery	Combined geriatric assessment	NR	22	NR	NR	NR	NR	No outcome analysis	NR - significant postoperative decrease of ADL
Obeid et al[36]	United States	5	R	58448	NR	48	Colectomy (33% malignant causes)	Canadian frailty index	26	NR	15.9	4.6	NR	NR	30 d mortality and morbidity	OR = 14.4; 95%CI: 18.76-31.2
Neuman et al[37]	United States	6	R	12979	84	39	Colectomy for colorectal cancer	Johns Hopkins adjusted case mix system	NR	16	NR	NR	85.7	NR	1 yr survival	OR = 8.4; 95%CI: 6.4-11.1, P = 0.001
Robinson et al[68]	United States	4	P	60	75	97	Colectomy for colorectal cancer	Individual frailty score	10	6	10	2	NR	NR	Hospital and health care costs	NR - significant association to costs and length of stay
Tran Ba Loc et al[29]	France	7	P	1186	76	NR	Major colorectal surgery	Elderly POSSUM score	41	3	NR	2	NR	NR	30 d mortality	AUC 0.86 (0.81-0.92)
Tan et al[31]	China	6	P	83	82	NR	Colorectal resections	Fried frailty criteria	22	NR	29	0	NR	NR	30 d morbidity	OR = 4.08; 95%CI: 1.43-11.64, P = 0.006
Sabel et al[38]	United States	5	R	302	68	52	Colorectal resection	Psoas area; Psoas density	58	34	NR	NR	NR	NR	No outcome analysis	NR
Lieffers et al[39]	Canada	5	R	234	63	135	Colorectal resection	Skeletal muscle index	6	NR	NR	NR	NR	NR	Postoperative complications	OR = 4.6; 95%CI: 1.513.9, P = 0.007
Reisinger et al[50]	The Netherlands	5	P/R	340	69	50	Colorectal resection	L3 muscle index	21	24	NR	4.5	NR	NR	Postoperative complications	OR = 43.3; 95%CI: 2.74-685.2, P = 0.007
Huang et al[30]	China	6	P	142	62	62	Colorectal resection	L3 muscle index and gait speed and grip strength	28	NR	NR	NR	NR	NR	Postoperative complications	OR = 4.524, 95%CI: 1.584-12.921, P = 0.007

¹According to the Newcastle-Ottawa Scale ranging from 1 to 9 stars. Age and OS are presented as median values unless indicated otherwise. NR: Not reported; OS: Overall survival; OR: Odds ratio; P: Prospective trial; P/R: Retrospective analysis on prospectively collected data; R: Retrospective trial.

Table 3 Complies the characteristics of all trials which evaluated frailty in patients undergoing hepato-pancreatico-biliary resections

Ref.	Country	Quality score1	Study design	Sample size	Age (yr)	Male sex (%)	Surgery type	Parameter used to define frailty	Postoperative complication rate	Follow-up (mo)	30-d morbidity (%)	30-d mortality (%)	1-yr OS (%)	5-yr OS (%)	Outcome parameter	Frailty/outcome (OR)
Harimoto et al[40]	Japanese	6	R	186	67	40	Partial hepatectomy HCC	L3 muscle area	NR	60	NR	NR	NR	71	5 yr survival	OR = 0.9; 95%CI: 0.84-093, P = 0.002
van Vledder et al[41]	The Netherlands	5	R	196	65	61	Liver resection for CRLM	Skeletal muscle mass	NR	29	NR	NR	94	43	Overall survival	OR = 14.4; 95%CI: 18.76-31.2
Valero et al[42]	United States	7	R	96	62	61	Liver resection liver transplantation	Total psoas area and total psoas volume	29	26	NR	NR	82	47	Complication rate	OR = 3.06; 95%CI: 1.07-8.52, P = 0.003
Englesbe et al[43]	United States	5	R	163	53	NR	Liver transplantation	Total psoas area and psoas density	NR	36	NR	NR	NR	NR	Overall survival rate	OR = 0.27; 95%CI: 0.11-0.33, P = 0.001
Waits et al[44]	United States	8	R	348	51	62	Liver transplantation	Total psoas area and psoas density and age - summarized in new parameter "monomorphometric age"	NR	60	NR	NR	85	59	1 and 5 yr survival	OR = 1.04; 95%CI: 1.03-1.06, P = 0.001
Masuda et al[76]	Japanese	5	R	2014	48	50	Living donor liver transplantation	Total psoas area	18	60	NR	NR	75	89	1 and 5 yr survival	OR = 2,06; 95%CI: 1.1-4.2, P = 0.05
Kaido et al[32]	Japanese	6	P	124	54	NR	Living donor liver transplantation	Skeletal muscle mass and bioimpedance analysis	NR	60	NR	NR	80	73	1 and 5 yr survival	OR = 4.85; 95%CI: 2.092-11.79, P = 0.001
Peng et al[46]	United States	6	R	259	68	60	Liver resection for CRLM	Total psoas area	10	60	NR	NR	65	26	Postoperative complications	OR = 3.1; 95%CI: 1.14-8.29, P = 0.02
Amini et al[47]	United States	7	R	763	67	57	Pancreatic resection	Total psoas area and total psoas volume	48	24	0.5	48	76	24	Postoperative complications	OR = 1.79; 95%CI: 1.15-2.56, P = 0.002
Dale et al[33]	United States	9	P	76	67	55	Pancreaticoduodenectomy	Fried’s criteria, Short Physical Performance Battery, Vulnerable Elderly Survey	80	1	4	21	NR	NR	Postoperative complications	OR = 4.06, P = 0.01
Joglekar et al[48]	United States	6	R	118	65	75	Pancreatic resection	Total psoas index and psoas density	78	3	NR	23	NR	NR	Postoperative complications	OR = 2.78; 95%CI: 2.28-22, P = 0.02
Peng et al[45]	United States	6	R	557	66	53	Pancreatic resection	Total psoas area	47	36	NR	NR	62	3 a OS: 36	3 yr OS	OR = 1.68; 95%CI: 1.32-2.11; P = 0.001

¹According to the Newcastle-Ottawa Scale ranging from 1 to 9 stars. Age and OS are presented as median values unless indicated otherwise. NR: Not reported; OS: Overall survival; OR: Odds ratio; P: Prospective trial; P/R: Retrospective analysis on prospectively collected data; R: Retrospective trial.

Table 4 Makary et al[22] did report on the surgical outcomes of a large cohort of older patients in which frailty was assessed using a frailty scale based on the fried frailty phenotype

Characteristic
Weakness	Weakness should be assessed by grip strength and measured directly with a hand held JAMAR dynamometer (Sammons, Preston Rolyan). Three serial tests of maximum grip strength with the dominant hand will be performed and a mean of the three values will be calculated and adjusted by body mass index and gender. Actual weakness will be defined in the lowest 20th percentile of a community dwelling adults of 65 yr and older
Shrinking	Shrinking should be defined through a self-report as unintentional weight loss above 10 pounds during the last year
Exhaustion	Exhaustion should be measured by responses following 2 statements from the modified 10 items Center for Epidemiological Studies - Depression scale: "I felt that everything I did was an effort and I could not get going" and "How often in the last week did you feel way?" and will be given the opportunity to reply with 0 = rarely or none of the time (< 1 d); 1 = some or a little time (1-2 d); 2 = a moderate amount of time (3-4 d); and 3 = most of the time. Patients answering either with 2 or 3 will be classified as exhausted
Low activity	Physical activities should be assessed using the Minnesota Leisure Time Activities Questionnaire which includes frequency and duration. The focus should be placed on activities in the past 2 wk prior to operation. Weekly tasks will be converted to equivalent kilocalories of expenditure, and individuals reporting a weekly kilocalorie expenditure in the lowest 20th percentile for their gender will be classified as having low activity
Slow walking speed	Walking speed should be measured combining 3 trials of walking 15 feet at a normal pace for the patient. Patients with a walking speed in the lowest 20th percentile, adjusted for gender and height, will be scored as having a slow walking speed