Driessens, Heleen (2020) The relation of the Robinson Frailty Score to postoperative textbook outcome in hepatopancreatobiliary cancer surgery A sub analysis of the prospective cohort FRAIL study. thesis, Medicine.
Full text available on request.Abstract
INTRODUCTION: With the increasing proportion of people aged 65 years and older, the incidence of frailty also increases. There is a higher risk of developing adverse postoperative outcomes in the ageing and frail population. The Robinson Frailty Score (RFS) has been shown to predict postoperative outcomes in colorectal and cardiac surgery. Therefore, this study assesses the relation of the RFS to postoperative outcomes in terms of the composite endpoint of textbook outcome (TO) in hepatopancreatobiliary (HPB) surgery. METHODS: This sub analysis of the prospective cohort FRAIL study measured the RFS preoperatively, among patients with a surgical treated HPB tumour. The RFS consisted of seven frailty characteristics: Timed Up and Go, Katz Score, Mini-Cog, Charlson Comorbidity Index (CCI), anaemia of chronic disease, poor nutrition and geriatric syndrome of falls. Based on the score, patients were grouped into three categories: non-frail, pre-frail or frail. Primary outcome was postoperative TO, defined as no severe complication (Clavien-Dindo grade ≥IIIa), no length of hospital stay (LOS) >14 days, no readmission within 30 days after discharge and no 30-day postoperative mortality. Secondary endpoints were LOS, development of a complication, Comprehensive Complication Index and transfer to a non-home facility. RESULTS: A total of 73 patients were included, of which 26 patients (35.6%) were pre-frail and 1 patient (1.4%) was frail, therefore included in the pre-frail group. In total, 40 patients (54.8%) achieved TO. In the final multivariable backward logistic regression model, a longer operating time (OR 0.994, 95%-CI 0.990-0.998 per minute increase; p=0.003) and major type of surgery (OR 0.164, 95%-CI 0.028-0.952 for major surgery; p=0.044) were independent predictors for not achieving TO. In our data, the RFS was not significantly associated with TO. Pre-frail patients had a longer LOS, a higher rate of complications and a higher Comprehensive Complication Index. The rate of 30-day readmission and transfer to a non-home facility were lower in the pre-frail group. For TO, the criteria of no LOS >14 days was the least often achieved (n=48, 65.8%) and therefore had the greatest negative impact on achieving TO. CONCLUSIONS: Further studies on the subject of the relation between the RFS and TO in order to validate a simple frailty screening tool to predict TO across different surgical specialties are recommended.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Klaase, Prof. J.M. and Van Wijk, Drs. L. |
| Faculty: | Medical Sciences |
| Date Deposited: | 12 Sep 2023 11:27 |
| Last Modified: | 12 Sep 2023 11:27 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3682 |
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