title: Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery.
abstract: According to the United States census bureau 20% of Americans will be older than 65 years in 2030 and half of them will need an operation - equating to about 36 million older surgical patients. Older adults are prone to complications during gastrointestinal cancer treatment and therefore may need to undergo special pretreatment assessments that incorporate frailty and sarcopenia assessments. A focused, structured literature review on PubMed and Google Scholar was performed to identify primary research articles, review articles, as well as practice guidelines on frailty and sarcopenia among patients undergoing gastrointestinal surgery. The initial search identified 450 articles; after eliminating duplicates, reports that did not include surgical patients, case series, as well as case reports, 42 publications on the impact of frailty and/or sarcopenia on outcome of patients undergoing gastrointestinal surgery were included. Frailty is defined as a clinically recognizable state of increased vulnerability to physiologic stressors resulting from aging. Frailty is associated with a decline in physiologic reserve and function across multiple physiologic systems. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Unlike cachexia, which is typically associated with weight loss due to chemotherapy or a general malignancy-related cachexia syndrome, sarcopenia relates to muscle mass rather than simply weight. As such, while weight reflects nutritional status, sarcopenia - the loss of muscle mass - is a more accurate and quantitative global marker of frailty. While chronologic age is an important element in assessing a patient's peri-operative risk, physiologic age is a more important determinant of outcomes. Geriatric assessment tools are important components of the pre-operative work-up and can help identify patients who suffer from frailty. Such data are important, as frailty and sarcopenia have repeatedly been demonstrated among the strongest predictors of both short- and long-term outcome following complicated surgical procedures such as esophageal, gastric, colorectal, and hepato-pancreatico-biliary resections.
authors: Doris Wagner, Mara McAdams DeMarco, Neda Amini, Stefan Buttner, Dorry Segev, Faiz Gani, Timothy M Pawlik, Division of Surgical Oncology, Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States.
authors: Doris
authors: D
authors: Wagner
authors: Doris Wagner, Mara McAdams DeMarco, Neda Amini, Stefan Buttner, Dorry Segev, Faiz Gani, Timothy M Pawlik, Division of Surgical Oncology, Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States.
authors: Mara McAdams
authors: MM
authors: DeMarco
authors: Doris Wagner, Mara McAdams DeMarco, Neda Amini, Stefan Buttner, Dorry Segev, Faiz Gani, Timothy M Pawlik, Division of Surgical Oncology, Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States.
authors: Neda
authors: N
authors: Amini
authors: Doris Wagner, Mara McAdams DeMarco, Neda Amini, Stefan Buttner, Dorry Segev, Faiz Gani, Timothy M Pawlik, Division of Surgical Oncology, Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States.
authors: Stefan
authors: S
authors: Buttner
authors: Doris Wagner, Mara McAdams DeMarco, Neda Amini, Stefan Buttner, Dorry Segev, Faiz Gani, Timothy M Pawlik, Division of Surgical Oncology, Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States.
authors: Dorry
authors: D
authors: Segev
authors: Doris Wagner, Mara McAdams DeMarco, Neda Amini, Stefan Buttner, Dorry Segev, Faiz Gani, Timothy M Pawlik, Division of Surgical Oncology, Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States.
authors: Faiz
authors: F
authors: Gani
authors: Doris Wagner, Mara McAdams DeMarco, Neda Amini, Stefan Buttner, Dorry Segev, Faiz Gani, Timothy M Pawlik, Division of Surgical Oncology, Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States.
authors: Timothy M
authors: TM
authors: Pawlik
keywords: Frailty; Morbidity; Mortality; Outcomes; Sarcopenia