Association between frailty and patient outcomes after cancer surgery: a population-based cohort study,British Journal of Anaesthesia

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Association between frailty and patient outcomes after cancer surgery: a population-based cohort study
British Journal of Anaesthesia ( IF 9.1 ) Pub Date : 2022-01-14 , DOI: 10.1016/j.bja.2021.11.035
Julia F Shaw ₁ , Sunita Mulpuru ₂ , Tetyana Kendzerska ₃ , Husein Moloo ₄ , Guillaume Martel ₅ , Antoine Eskander ₆ , Manoj M Lalu ₇ , Daniel I McIsaac ₇

Affiliation

University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada.
University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Respirology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Respirology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, ON, Canada.
University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, ON, Canada.
University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Department of Otolaryngology-Head & Neck Surgery, Toronto, ON, Canada.
University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, ON, Canada.

Background

Frailty is associated with poor postoperative outcomes, but existing data do not describe frailty's interaction with tumour characteristics at the time of cancer surgery. Our objective was to estimate the association between frailty and long-term survival, and to explore any interaction with tumour stage and grade.

Methods

This was a population-based cohort study conducted using linked provincial health administrative data in Ontario, Canada (2009–20). Using a cancer registry, we identified adults having elective cancer surgery. Frailty was measured using a validated index (range 0–1; higher score=greater frailty). Associations between frailty and long-term postoperative survival (primary outcome) were estimated using proportional hazards regression. Secondary outcomes were length of stay, discharge destination, days alive at home, and healthcare costs.

Results

We identified and included 52 012 patients. Mean frailty score was 0.13 (standard deviation 0.07). During follow-up, 19 378 (37.3%) patients died. After adjustment for risk factors, each 10% increase in frailty was associated with a 1.60-fold relative decrease in survival (95% confidence interval: 1.56–1.64). The frailty–survival association was strongest for patients with lower stage and grade cancers. Increased frailty was associated with longer hospital stays (3 days), fewer days alive and at home (42 days yr⁻¹), more frequent discharge to a nursing facility (2.38-fold), and increased healthcare costs ($6048).

Conclusions

Patient frailty is associated with decreased long-term survival after cancer surgery. The association is stronger for early-stage and -grade cancers, which would otherwise have a better survival prognosis.

中文翻译：

癌症手术后虚弱与患者预后之间的关联：基于人群的队列研究

背景

衰弱与不良的术后结果相关，但现有数据并未描述衰弱与癌症手术时肿瘤特征的相互作用。我们的目标是估计虚弱和长期生存之间的关联，并探索与肿瘤分期和分级的任何相互作用。

方法

这是一项基于人群的队列研究，使用加拿大安大略省相关的省级卫生行政数据（2009-20 年）。使用癌症登记处，我们确定了接受选择性癌症手术的成年人。使用经过验证的指数（范围 0-1；分数越高=越虚弱）来测量虚弱程度。使用比例风险回归估计虚弱和长期术后生存（主要结果）之间的关联。次要结果是住院时间、出院目的地、在家中的生存天数和医疗保健费用。

结果

我们确定并纳入了 52 012 名患者。平均虚弱评分为 0.13（标准差 0.07）。随访期间，19 378 例（37.3%）患者死亡。调整风险因素后，虚弱程度每增加 10%，生存率相对下降 1.60 倍（95% 置信区间：1.56-1.64）。对于较低阶段和级别的癌症患者，虚弱-生存关联最强。虚弱增加与住院时间延长（3 天）、在家和在家的生存天数减少（每年^-1 42 天）、更频繁地出院（2.38 倍）和医疗保健费用增加（6048 美元）有关。