Abstract
BackgroundFrailty results in a high risk for disability, hospitalization, and mortality. This study aimed to investigate perioperative details of frail patients who underwent pancreatectomy and whether frailty can be a predictive factor of postoperative complications, especially of clinically relevant postoperative pancreatic fistula (CR-POPF).MethodsThis retrospective study included patients who underwent pancreatectomy in our hospital between August 2016 and March 2019. The patients were divided into frail and pre-/non-frail groups. The diagnostic criteria were based on the Japanese version of the Cardiovascular Health Study.ResultsOf 93 patients, 11 (11.8%) and 82 (88.2%) were frail and pre-/non-frail patients, with median ages of 82 and 72 years, respectively (p = 0.041). Postoperative complications (Clavien-Dindo ≧ IIIa) were found in 8 and 32 patients (p = 0.034), CR-POPF in 3 and 13 patients (p = 0.346), and postoperative hospital stays were 21 and 17 days (p = 0.041), respectively. On multivariate analysis, frailty was an independent predictive factor (odds ratio [OR] 5.604, 95.0% confidence interval [CI] 1.002-30.734; p = 0.047) of postoperative complications (Clavien-Dindo ≧ IIIa) after pancreaticoduodenectomy. On multivariate analysis, a soft pancreas (OR 5.696, 95.0% CI 1.142-28.149; p = 0.034) was an independent and significant predictive factor of CR-POPF after pancreaticoduodenectomy.ConclusionsFrailty may be a useful predictive factor of postoperative complications in patients undergoing pancreaticoduodenectomy.
Highlights
Frailty results in a high risk for disability, hospitalization, and mortality
Our secondary aim was to evaluate whether frailty can be a predictive factor of postoperative complications (Clavien-Dindo classification ≥ IIIa) (CD ≥ IIIa) or clinically relevant postoperative pancreatic fistula (CR-POPF; grades B/C POPF)
We especially focused on CRPOPF according to 2016 the International Study Group of Pancreatic Fistula classification [17]
Summary
Frailty results in a high risk for disability, hospitalization, and mortality. This study aimed to investigate perioperative details of frail patients who underwent pancreatectomy and whether frailty can be a predictive factor of postoperative complications, especially of clinically relevant postoperative pancreatic fistula (CR-POPF). Frailty has become the center of attention in the geriatric field because it is considered to result in a high risk for falls, disability, hospitalization, and mortality [1]. Sarcopenia can be considered one of the main physical drivers of frailty or even a precursor state [7], and it has been considered one of the risk stratification tools to better identify potentially high-risk surgical patients [8]. Several reports [5, 10, 11] have reported frailty as an important independent predictor of outcomes after pancreatic surgery; to the best of our knowledge, the relationship between frail patients and pre-/non-frail patients or that between frailty and sarcopenia has not been extensively studied
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