403. FRAILTY AS A PREDICTOR OF POSTOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING ESOPHAGECTOMY

Abstract

Abstract Careful selection and optimization of esophageal cancer patients for esophagectomy is necessary and has been shown to improve outcomes. Preoperative frailty measures, both objective and subjective, may predict postoperative outcomes after minimally invasive esophagectomy (MIE) and be applied to surgical decision-making and patient selection. We hypothesize that measures of increased frailty are associated with major complications after MIE for esophageal cancer. This is a prospective cohort study of patients undergoing MIE for esophageal cancer in a US academic tertiary hospital over one year (2021). We tested preoperative frailty by measuring two-flight stair climb times, pulse change during stair climb, grip strength, and Edmonton Frail Scale (EFS) score. Postoperative complications in the first 30 days were classified based on Clavien-Dindo, with Grade III or above defined as a major complication (primary outcome). We calculated Spearman correlations among the four different frailty measures. We performed t-tests to compare frailty measures in patients with and without major complications. Thirty-four patients were enrolled with a mean age of 64 (SD 11) and 79.4% male. EFS score, grip strength, and stair climb time were significantly correlated (p < 0.05), as shown in Figure 1. There was a significant difference in EFS scores between groups with or without major complications (4.7 vs 3.0, p = 0.04, respectively), with a higher score representing increased frailty. Other frailty measures did not meet significance between groups for major complication, including stair climb time (difference of 11.0 s, 95% CI: −0.38-22.4) and grip strength (difference of 7.7 kg, 95% CI: −0.94-16.3). No difference was seen in pulse change by complication status. A higher Edmonton Frail Scale score is associated with major postoperative complications following MIE. Patients with higher EFS score should be counseled on increased surgical risk of morbidity and prehabilitation should be considered. Other measures such as stair climb time and grip strength may support the preoperative frailty assessment in esophageal cancer patients, as they were highly correlative with each other.