Modified Frailty Index is Useful in Predicting Non-home Discharge in Elderly Patients with Gastric Cancer Who Undergo Ga
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ORIGINAL SCIENTIFIC REPORT
Modified Frailty Index is Useful in Predicting Non-home Discharge in Elderly Patients with Gastric Cancer Who Undergo Gastrectomy Tomohiro Osaki1 • Hiroaki Saito2 • Shota Shimizu3 • Yuki Murakami2 • Kozo Miyatani3 • Tomoyuki Matsunaga3 • Shigeru Tatebe1 • Masahide Ikeguchi1 • Yoshiyuki Fujiwara3
Accepted: 1 July 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Development of laparoscopic gastrectomy and the Enhanced Recovery After Surgery (ERAS) protocol enable early discharge to home of patients with gastric cancer (GC). However, a significant proportion of patients are still discharged to inpatient facilities after surgery. We aimed to identify predictive factors of non-home discharge in patients with GC who undergo gastrectomy. Methods We enrolled 517 patients with histopathologically confirmed diagnosis of GC who underwent gastrectomy. Results The number of patients with non-home discharge was 23 (4.4%), and non-home discharge was only observed in patients with GC aged C65 years. Patients were divided into the mFIHigh (C0.272) and mFILow (\0.272) groups according to the cut-off value determined by ROC analysis. The mFIHigh classification was significantly more frequent in patients aged C75 years, who underwent either total or proximal partial gastrectomy, who underwent limited lymph node dissection, and with non-home discharge than in patients aged \75 years (p = 0.0002), those who underwent distal partial gastrectomy (p = 0.032), those who underwent standard lymph node dissection (p = 0.036), and those without non-home discharge (p = 0.0071). Multivariate analysis revealed mFI as an independent predictive indicator of non-home discharge, along with postoperative complications and surgical approach, in patients with GC aged C65 years. The frequency of patients with non-home discharge was significantly associated with the number of these three predictive factors in GC patients aged C65 years (p \ 0.0001). Conclusions The combination of mFI, postoperative complications, and surgical approach is useful for predicting non-home discharge in patients aged C65 years who underwent gastrectomy for GC.
Introduction
& Tomohiro Osaki [email protected] 1
Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori 680-0901, Japan
2
Department of Surgery, Japanese Red Cross Tottori Hospital, 117 Shotoku-cho, Tottori 680-8517, Japan
3
Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago 683-8504, Japan
Gastric cancer (GC) is the third leading cause of cancer death worldwide [1]. The mainstay curative treatment for GC is gastrectomy with regional lymph node dissection. Although morbidity and mortality rates after gastrectomy are low [2], some patients suffer from postoperative complications [3], which can worsen their short-term outcomes by increasing their hospital stay or requirement for fasting. The postoperative nutritional status of some patients worsens compar
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