title: Use of a simplified frailty index to predict Clavien 4 complications and mortality after hepatectomy: analysis of the National Surgical Quality Improvement Project database.
abstract: BACKGROUND
  An aging surgical population places an increasing burden on surgeons to accurately risk stratify and counsel patients. Preoperative frailty assessments are a promising new modality to better evaluate patients but can often be time consuming. Data regarding frailty and hepatectomy outcomes have not been published to date.
  
  
  METHODS
  Using the National Surgical Quality Improvement Project database, we examined hepatectomy patients 2005 to 11 and correlated frailty scores with outcomes of major morbidity, mortality, and extended length of stay, using a previously validated modified frailty index score. Frailty was compared against age, American Society of Anesthesiologists class, and other common risk variables.
  
  
  RESULTS
  Multivariate regression identified frailty as the strongest predictor of Clavien 4 complications (OR = 40.0, 95% CI = 15.2 to 105.0), and mortality (OR = 26.4, 95% CI = 7.7 to 88.2). As the frailty score increased, there was a statistically significant increase in Clavien 4 complications, mortality, and extended length of stay (P < .001 for all).
  
  
  CONCLUSIONS
  Frailty is a significant factor in morbidity and mortality after hepatectomy. Use of the modified frailty index allows for feasibility of data collection in a busy clinical setting.
authors.affiliation: Department of Acute Care Surgery/Surgical Critical Care, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202. Electronic address: lisalouwers27@gmail.com.
authors.forename: Lisa
authors.initials: L
authors.lastname: Louwers
authors.affiliation: Division of Transplant and Hepatobiliary Surgery, Henry Ford Transplant Institute, Henry Ford Hospital, Detroit, MI.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Schnickel
authors.affiliation: Department of Acute Care Surgery/Surgical Critical Care, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202.
authors.forename: Ilan
authors.initials: I
authors.lastname: Rubinfeld
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D016330:Frail Elderly; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality*; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States
keywords: Clavien 4; Frailty; Frailty index; Hepatectomy; National Surgical Quality Improvement Project