title: Modified Frailty Index Predicts Morbidity and Mortality After Pancreaticoduodenectomy.
abstract: BACKGROUND
  Pancreatic cancer is a disease of older adults, who may present with limited physiologic reserve. The authors hypothesized that a frailty index can predict postoperative outcomes after pancreaticoduodenectomy (PD).
  
  
  METHODS
  All patients who underwent PD were identified in the 2005-2012 NSQIP Participant Use File. Patients undergoing emergency procedures, those with an American Society of Anesthesiologists (ASA) classification of five, and those with a diagnosis of preoperative sepsis were excluded from the study. A modified frailty index (mFI) was defined by 11 variables within the National Surgical Quality Improvement Program (NSQIP) previously used for the Canadian Study of Health and Aging-Frailty Index. An mFI score of 0.27 or higher was defined as a high mFI. Uni- and multivariate analyses were performed to evaluate postoperative outcomes.
  
  
  RESULTS
  This study enrolled 9986 patients (age 65 ± 12 years, 48.8% female) who underwent PD. Of these patients, 6.4% (n = 637) had a high mFI (>0.27). Increasing mFI was associated with higher prevalence of postoperative morbidity (p < 0.001) and 30-days mortality (p < 0.001). In the univariate analysis, high mFI was associated with increased morbidity (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.43-1.97; p < 0.001) and 30-days mortality (OR 2.45; 95% CI 1.74-3.45; p < 0.001). After adjustment for age, sex, ASA classification, albumin level, and body mass index (BMI), high mFI remained an independent preoperative predictor of postoperative morbidity (OR 1.544; 95% CI 1.289-1.850; p < 0.0001) and 30-days mortality (OR 1.536; 95% CI 1.049-2.248; p = 0.027).
  
  
  CONCLUSIONS
  High mFI is associated with postoperative morbidity and mortality after PD and can aid in preoperative risk stratification.
authors.affiliation: Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Harveshp
authors.initials: H
authors.lastname: Mogal
authors.affiliation: Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Vermilion
authors.affiliation: Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dodson
authors.affiliation: Department of Biostatistical Sciences, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Fang-Chi
authors.initials: FC
authors.lastname: Hsu
authors.affiliation: Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Russell
authors.initials: R
authors.lastname: Howerton
authors.affiliation: Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
authors.affiliation: Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA. cjclark@wakehealth.edu.|Division of Surgical Oncology, Department of Surgery, Medical Center Boulevard, Winston-Salem, NC, USA. cjclark@wakehealth.edu.
authors.forename: Clancy J
authors.initials: CJ
authors.lastname: Clark
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D000073496:Frailty / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011183:Postoperative Complications; D011379:Prognosis; D058996:Quality Improvement; D018570:Risk Assessment; D015996:Survival Rate