Fitness scale-4 item (FS4) to predict six-month postoperative mortality of cancer patients aged 75.

Abstract

11542 Background: We have been prospectively collecting Geriatric Assessment (GA) data on patients aged 75+ undergoing oncologic surgery at a single institution. We aimed to to determine if a fitness scale based on a limited number of easily captured datafields can be developed, validated, and associated with 6 month postoperative mortality. Methods: From patients referred to Memorial Sloan Kettering (MSK) Geriatrics Service for preoperative GA since 2015, we have selected patients who were aged 75+, had elective surgery, with hospital length of stay (LOS) of ≥1 day, and had at least 6-month follow up. The Fitness Scale-4 item (FS4) is composed of 3 variables from the GA; Karnofsky Performance Scale (KPS), ability to walk outside, ability to perform housekeeping, and additional variable of preoperative albumin level. The FS4 total score ranges from 0-8 (frail = 0-2, vulnerable = 3-5, and fit = 6+). We validated this scale against prevalence of geriatric syndromes in each fitness category. We performed multivariable regression (MVR) analysis to assess the odds of six-month postoperative mortality among vulnerable and frail patients vs. fit patients. Results: Out of 1270 patients (median age 79, IQR 77-83), 792 (61.4%), 327 (25.7%) and 151 (11.9%) were fit, vulnerable, and frail, respectively. All of the geriatric syndromes were more prevalent among frail and vulnerable patients than fit patients. Six-month mortality rate was 4.7%, 12.5%, and 21.2% for fit, vulnerable, and frail patients, respectively. In the MVR analysis, and after adjustment for age, gender, ASA PS, LOS, operation time, KPS, and preoperative albumin, the odds of six-month mortality among frail (OR = 4.58, p = 0.004) and vulnerable patients (OR = 2.63, p = 0.004) vs. fit patients were much higher. Conclusions: Frail and vulnerable patients based on FS4 are at significantly higher risk for six-month postoperative mortality vs. fit patients. Future studies should assess the external validation of FS4, and its impact on surgical decision making, and perioperative care of older cancer patients.