Higher Preop Research Articles

P11.56.A MODIFIED FRAILTY INDEX (MFI) AS A SURVIVAL AND FUNCTIONAL OUTCOME PREDICTOR IN OLDER PATIENTS UNDERGOING SURGERY FOR BRAIN METASTASES

Abstract BACKGROUND Surgical decision making in older patients with brain metastases (BM) is challenging. Frailty and comorbidities are often thought to limit therapeutic options as well as functional and survival outcomes. MATERIAL AND METHODS 139 consecutive patients undergoing surgery 2017-2021 for BM were analyzed retrospectively. Cut-off for age was ≥60 yrs. in accordance with the graded prognostic assessment (GPA) index. Frailty was investigated using the mFI index, a compound measure assessing comorbidities and the patients’ functional health status. RESULTS Median age was 69.0 (IQR: 63.0-74.5) yrs. 55.4% had multiple metastases. We recorded 9.4% major (CTCAE III-V) surgical and 10.1% medical complications. 7.9% of patients had major new focal neurological deficits ≥30 days. Median overall survival (mOS) was 7.8 (IQR: 5.0-10.6) months. Frailer patients lived shorter (mOS for “least-frail”/mFl 0: 13.6 [IQR: 8.6-18.6], “moderately frail”/mFl 1-2: 9.0 [IQR: 4.9-13.0] and “frailest”/mFl ≥3: 2.7 [IQR: 0.9-4.5] months; p<0.001). Multivariate analysis with all parameters correlating significantly with mOS in the univariate analysis (mFI, higher preop. KPS, younger age [<69 yrs.], female sex) revealed a higher preop. KPS to be the only independent significant survival predictor (70 vs. 80-100; HR 2.1, p<0.001). Frailer patients had poorer functional outcomes (patients w/ postop. KPS ≤70 vs. 80-100; mFI 0: 9/36 [25.0%], mFI 1-2: 20/65 [30.8%], mFI ≥3: 25/38 [65.8%]; p<0.001). Multivariate analysis with all parameters correlating significantly with better functional outcome in the univariate analysis (mFI, higher preop. KPS, younger age, female sex and single metastasis) showed that a higher preop. KPS was the strongest prognostic parameter (RR 17.2, p<0.001). The mFI was not an independent outcome predictor. In a ROC analysis the preoperative KPS proved a much better predictor of functional outcome than the mFI (AUC 92 vs. 71%; sensitivity/specificity optimum 80 vs. 2, resp.). mFI was not a predictor of complications (p=NS). CONCLUSION The mFI proved a strong survival and functional outcome predictor in older patients. However, this effect was no longer seen in multivariate analyses when the KPS was included as a covariate. This may suggest that surgical outcomes depend on the patients’ presurgical functional health status rather than comorbidities. The presence of comorbidities (if well treated) should therefore not deter from BM surgery in older patients.

1314 COMPARISON OF LAPAROSCOPIC AND OPEN RENAL SURGERY –FINDINGS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM

INTRODUCTION AND OBJECTIVES: Laparoscopic renal surgeries are increasingly performed. We analyzed preoperative patient characteristics, perioperative parameters, and postoperative complication rates for laparoscopic and open partial and radical nephrectomies in a nationwide database. METHODS: American College of Surgeons National Surgical Quality Improvement Program (NSQIP) contains risk-adjusted clinical outcomes data. From 2005-2009, we identified 261 cases of laparoscopic partial (LPN, CPT 50543), 405 cases of open partial (OPN, CPT 50240), 688 cases of laparoscopic radical (LRN, CPT 50545, 50546), and 759 cases of open radical nephrectomies (ORN, CPT 50230, 50225, 50220). RESULTS: Comparing LPN and OPN, no differences in preoperative characteristics such as age, BMI, smoking, diabetes, cardiopulmonary or bleeding disorders, were found. There was a significant difference in need for intraoperative blood transfusion (LPN 3.4%, OPN 7.9%, p 0.006). Total operative time was shorter for OPN than LPN (184 vs. 220 min, p 0.001), and length of hospital stay longer (5.9 vs. 3.2 days, p 0.001). Postoperative acute renal failure (ARF) rate was higher for OPN (1.7% vs. 0% for LPN, p 0.033), however likely cofounded by higher preop creatinine levels for OPN (1.11 vs. 0.98 for LPN, p 0.025). Differences in superficial wound infections (LPN 0%, OPN 1.7%, p 0.033), post-op urinary infections (LPN 0.4%, OPN 4.0%, p 0.004), and the need to return to the OR (LPN 1.1%, OPN 4.2%, p 0.044) were present. LRN patients were more likely diabetic than ORN pts (21.5% vs. 16.1%, p 0.01) and less likely smokers (17.0% vs. 22.1%, p 0.014) or hypertensive (5.5% vs. 41.4%, p 0.021). Preoperative renal failure was increased in ORN compared to LRN (2% vs. 0.6%, p 0.02), as was higher ASA class (p 0.001). Again, intra-operative transfusion rates were significantly higher in ORN than LRN (25.2% vs. 3.9%, p 0.001) and ORN patients had a longer hospital stay (7.4 days vs. 4.4 days, p 0.001). Compared to LRN, ORN was associated with greater likelihood of post-op pneumonia (4.0% vs. 0.4%, p 0.001), ARF (1.8% vs. 0.6%, P 0.03), DVT (1.1% vs. 0.1%, p 0.028), and sepsis (3.0% vs. 1.2%, p 0.014). Also, there were more occurrences of post-op bleeding for ORN than LRN (1.8%. vs. 0.4%, p 0.013) and need to return to the OR (6.9% vs. 3.1%, p 0.0015). CONCLUSIONS: Both laparoscopic partial and radical nephrectomies are associated with shorter hospital stay, decreased blood transfusion, less ARF and less frequent returns to the OR. However patients undergoing open radical nephrectomy appear to be in overall worse health.