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Authors: Anic, Katharina
Flohr, Friedrich
Schmidt, Mona Wanda
Krajnak, Slavomir
Schwab, Roxana
Schmidt, Marcus
Westphalen, Christiane
Eichelsbacher, Clemens
Ruckes, Christian
Brenner, Walburgis
Hasenburg, Annette
Battista, Marco Johannes
Title: Frailty assessment tools predict perioperative outcome in elderly patients with endometrial cancer better than age or BMI alone : a retrospective observational cohort study
Online publication date: 30-Jan-2023
Year of first publication: 2022
Language: english
Abstract: Objective Five commonly used global health assessment tools have been evaluated to identify and assess the preoperative frailty status and its relationship with perioperative in-hospital complications and transfusion rates in older women with endometrial cancer (EC). Methods Preoperative frailty status was examined by the G8 questionnaire, the Eastern Cooperative Oncology Group performance status, the Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status System, as well as the Lee-Schonberg prognostic index. The main outcome measures were perioperative laboratory values, intraoperative surgical parameters and immediately postoperative complications. Results 153 consecutive women ≥ 60 years with all stages of EC, who received primary elective surgery at the University Medical Center Mainz between 2008 and 2019 were classified with selected global health assessment tools according to their preoperative performance status. In contrast to conventional prognostic parameters like older age and higher BMI, increasing frailty was significantly associated with preoperative anemia and perioperative transfusions (p < 0.05). Moreover, in patients preoperatively classified as frail significantly more postoperative complications (G8 Score: frail: 20.7% vs. non-frail: 6.7%, p = 0.028; ECOG: frail: 40.9% vs. non-frail: 2.8%, p = 0.002; and CCI: frail: 25.0% vs. non-frail: 7.4%, p = 0.003) and an increased length of hospitalization were recorded. According to propensity score matching, the risk for developing postoperative complications for frail patients was approximately two-fold higher, depending on which global health assessment tool was used. Conclusions Preoperatively assessed frailty significantly predicts post-surgical morbidity rates in contrast to conventionally used single prognostic parameters such as age or BMI. A standardized preoperative assessment of frailty in the routine work-up might be beneficial in older cancer patients before major surgery to include these patients in a prehabilitation program with nutrition counseling and physiotherapy to adequately assess the perioperative risk.
DDC: 610 Medizin
610 Medical sciences
Institution: Johannes Gutenberg-Universität Mainz
Department: FB 04 Medizin
Place: Mainz
Version: Published version
Publication type: Zeitschriftenaufsatz
License: CC BY
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Journal: Journal of cancer research and clinical oncology
Version of Record (VoR)
Publisher: Springer
Publisher place: Berlin u.a.
Issue date: 2022
ISSN: 1432-1335
Publisher DOI: 10.1007/s00432-022-04038-6
Appears in collections:DFG-491381577-H

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