Is Frailty Score a Better Post-Operative Outcome Predictor Than Age in Patients Undergoing Pancreatectomy?

Introduction: The modified frailty index (mFI) is a robust predictor of postoperative outcomes for surgical patients. The present study compares the prediction effect of mFI versus age on postoperative outcomes in patients undergoing pancreatic surgery. Method: All patients who underwent pancreatic surgery were identified in the 2012–2019 National Surgical Quality Improvement Program (NSQIP). The mFI was defined by 5 variables within NSQIP. Chi-square tests were utilized to determine the associations between age, frailty, and morbidity, and mortality. Logistic regression modeling was used to evaluate these associations while adjusting for potential confounders. Results: A total of 56,465 patients were included in the study. Higher mFI and older age were both associated with a higher risk of morbidity and mortality (in univariate analysis (p<0.001). After adjustment for confounders, high mFI remained an independent preoperative predictor of postoperative mortality (OR 5.45; 95% CI [4.14-7.17]; p < 0.001) and morbidity (OR 4.72; 95% CI [4.19-5.31]; p<0.001). Older age was associated with higher risk of mortality (OR 3.52; 95%CI [1.72-7.22]; P<0.001) but not morbidity (OR 1.13; 95%CI [0.99-1.27]; p=0.22) Conclusions: Frailty is a better predictor of post-op outcomes than age, which supports the inclusion of frailty scores such as mFI in the NSQIP risk calculator and preoperative discussion with patients.