title: Frailty index predicts severe complications in gynecologic oncology patients.
abstract: OBJECTIVE
  The purpose of this study was to quantify the predictive value of frailty index on 30-day Clavien class IV (requiring critical care support) and class V (30-day mortality) complications after gynecologic cancer surgery.
  
  
  METHODS
  Patients included in the National Surgical Quality Improvement Program (NSQIP) 2008-2011 had a final diagnosis of gynecologic malignancy. Modified frailty index (mFI) was calculated with 11 variables. Higher mFI scores indicated more severe comorbidities. Logistic regression was used to control for known predictors of complications.
  
  
  RESULTS
  Of the total 6551 patients, 188 (2.9%) of the patients experienced a Clavien IV/V complication. 2958 patients had a score of 0 (45.2%), 2405 patients had a score of 1 (36.7%), 985 patients had a score of 2 (15%), 162 patients had a score of 3 (2.5%) and 41 patients had a score≥4 (0.6%). The rates of Clavien IV/V complications were 2%, 2.7%, 4.4%, 7.4% and 24.4% for mFI scores of 0, 1, 2, 3 and ≥4, respectively (p<0.001). Variables found to be significant for predicting Clavien IV and V complications on logistic regression modeling were preoperative albumin<3g/dL (OR=6.5), operative time (OR=1.003 per min increase), non-laparoscopic surgery (OR=3.3), and frailty index (OR score 0=reference, score 1=1.26, score 2=1.9, score 3=2.33 and score≥4=12.5). Taking the two preoperative factors of albumin and mFI allowed for greater precision in identifying women who are at higher risk for requiring ICU care (>10% risk).
  
  
  CONCLUSIONS
  Modified frailty index (mFI) is predictive of the need for critical care support and 30-day mortality after surgery for gynecologic cancer.
authors.affiliation: Division of Gynecologic Oncology, University of Wisconsin, Madison, WI, United States. Electronic address: Shitanshuuppal@gmail.com.
authors.forename: Shitanshu
authors.initials: S
authors.lastname: Uppal
authors.affiliation: Department of Obstetrics Gynecology, Temple University Hospital, Philadelphia, PA, United States.
authors.forename: Elena
authors.initials: E
authors.lastname: Igwe
authors.affiliation: Division of Gynecologic Oncology, University of Wisconsin, Madison, WI, United States.
authors.forename: Laurel W
authors.initials: LW
authors.lastname: Rice
authors.affiliation: Division of Gynecologic Oncology, University of Wisconsin, Madison, WI, United States.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Spencer
authors.affiliation: Division of Gynecologic Oncology, University of Wisconsin, Madison, WI, United States.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Rose
mesh_terms: D000368:Aged; D003422:Critical Care; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Critical care; Frailty; NSQIP; Surgical complications; Surgical outcomes