Frailty index predicts severe complications in gynecologic oncology patients

•Preoperative quantification of frailty can help predict surgical outcomes.•Patients with high frailty index score have high likelihood of intensive care utilization and prolonged recovery.•Poor nutritional status with high frailty represents a very high risk group.

ObjectiveThe 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.MethodsPatients 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.ResultsOf 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 < 3 g/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).ConclusionsModified frailty index (mFI) is predictive of the need for critical care support and 30-day mortality after surgery for gynecologic cancer.