Self-reported Exhaustion and a 4-item Physical Frailty Index to Predict the Incidence of Major Complications after Onco-Geriatric Surgery

Background The aim of this study was to analyze four pre-operative physical frailty indicators from a geriatric assessment (GA) independently and combined in a physical frailty index, in their ability to predict postoperative 30d- complications. Materials and Methods In this secondary analysis of data from the published PERATECS study (ClinicalTrials.gov: NCT01278537), the predictive value of four physical frailty indicators from a defined GA battery was examined with univariable and multivariate logistic regression models in a sample of 493 onco-geriatric surgical patients. The primary endpoint was incidence of major (Clavien–Dindo≥grade 2 [CD≥2]) complications within 30 postoperative days.Predictors of the first model included self-reported exhaustion (SRE), body mass index (BMI), Timed Up-and-Go (TUG) and handgrip strength (HGS) independently, and a second model combined these four items as a Physical Frailty Index (4i-PFI). Both regression models were adjusted for age, gender, American Society of Anesthesiologists (ASA) status, tumor sites, duration of surgery time and Mini Nutritional Assessment (MNA) score. Results A total of 233 patients (47%) developed CD≥2 complications. In addition to ASA score, length of surgery, and gynecological and upper gastrointestinal tumor sites, the first model showed that SRE (OR 1.866) predicted CD≥2 complications, but not TUG, BMI and HGS. In the second model, the 4i-PFI predicted CD≥2 complications (OR pre-frail =1.808, frail =3.787). Conclusions Physical frailty indicators as SRE revealed a better ability to predict CD≥2 complications than BMI, TUG and HGS. However, prediction of CD≥2 complications was enhanced when these parameters were combined in a novel 4i-PFI.