The Impact Of Frailty On Patients Undergoing Liver Resection For Colorectal Liver Metastasis: A Review Of The National Surgical Quality Improvement Program

Abstract

Presenter: Jacqueline Dauch MD | University of Arizona Background: Frailty is highly prevalent in patients with malignancy and is associated with high risk of morbidity and mortality after operative interventions. However, the impact of frailty on patients undergoing liver resection for metastatic colorectal cancer has not been studied. The aim of this study was to assess the impact of frailty on short term outcomes after liver resection in patients with metastatic colorectal cancer to the liver. Methods: We performed a 4 year analysis of the National Surgical Quality Improvement Program (NSQIP) participant user files. All patients undergoing hepatectomy for metastatic colorectal cancer between 2014-2017 were reviewed. The 5-item Modified Frailty Index (mFI) was calculated using NSQIP variables. We included all patients with complete mFI information in the analysis. Patients were divided into three categories based on the mFI (0= no frailty indicators, 1=one frailty indicator, 2=two or more frailty indicator). Outcome measures in house included minor and major morbidity as defined by the Clavien-Dindo classification (I/II vs III/IV), 30 day mortality, need for readmission, unfavorable discharge (not to home), bile leak and liver failure. Results: A total of 5230 patients were included in the analysis. 2737 (52%) had a mFI score of 0, 1839 (35%) had a mFI score of 1, and 654 (13%) had a mFI score of 2 or more. On multivariate analysis and after adjusting for potential cofounders such as age, sex, race/ethnicity, BMI, ASA class, preoperative albumin, neoadjuvant chemotherapy and extent of surgery (minor vs major ); patients with a mFI score of 2 or over were more likely than those with mFI of 0 to experience minor morbidity (OR 1.47, 95% CI 1.14-1.91, p<0.01), major morbidity (OR 1.82, 95% CI 1.29-2.55, p<0.01), readmission (OR 1.56 95% CI 1.10-2.23, p<0.01), non-home discharge (OR 2.81, 95% CI 1.74-4.50, p<0.01), and bile leak (OR 1.64 95% CI.05-2.54, p=0.03). Those with a mFI score of 1 were more likely than those with mFI 0 to experience non-home discharge (OR 1.54 95% CI 1.03-2.31 p=0.04) and liver failure (OR 1.63, 95% CI 1.14-2.45, p<0.01). Conclusion: Frailty is associated with increased risk of morbidity, unfavorable discharge, readmission and bile leak in patients undergoing liver resection for metastatic colorectal cancer. We recommend the use of the 5-item Modified Frailty Index to guide risk stratification, optimization and counseling.