The Comprehensive Complication Index is Related to Frailty in Elderly Surgical Patients

• Published in: The Journal of surgical research 2019-12, Vol.244, p.218-224
• Main Authors: Artiles-Armas, Manuel, Roque-Castellano, Cristina, Conde-Martel, Alicia, Marchena-Gómez, Joaquín
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Comprehensive complication index; Cross-Sectional Studies; Digestive System Surgical Procedures - adverse effects; Elderly; Female; Frail Elderly - statistics & numerical data; Frailty; Frailty - diagnosis; Frailty - etiology; Gastrointestinal Neoplasms - complications; Gastrointestinal Neoplasms - surgery; Geriatric Assessment - methods; Geriatric Assessment - statistics & numerical data; Humans; Male; Post-operative outcome; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prognosis; Prospective Studies; Risk Factors
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2019.06.011

Frailty has been proposed as an independent risk factor for predicting postsurgical outcomes in elderly surgical patients. The Comprehensive Complication Index (CCI) seems to be the most widely used grading of individual complications in many surgical fields. The objective of this study was to evaluate the association of frailty, measured by Canadian Study of Health and Aging–Clinical Frailty Scale (CSHA-CFS), with the CCI in the elderly surgical patient. A prospective cross-sectional study was carried out in 256 patients aged ≥70 y who underwent major gastrointestinal surgery. Sociodemographic characteristics, baseline disease, CSHA-CFS, and medical/surgical complication using the Comprehensive Comorbidity Index were evaluated. We hypothesized that frailty measured by CSHA-CFS and the CCI are associated. Of 256 patients, 154 (60%) were men and 102 (40%) were women, with mean age of 76.1 y (SD ± 5.1). One-hundred and eighty-five patients (74%) underwent surgery for a malignant cause, and 97 patients (38%) had some degree of frailty. Mean CCI was 16.1 (SD ± 23.0). Postoperative mortality was 3%. Pondering the scale CCI 0-100, frailty correlated well with postoperative complications (P = 0.035). For patients who developed at least 1 complication, for each unit that the CSHA-CFS was raised, the CCI increased by 5.2 points (P = 0.002). The multivariate analysis showed that the CSHA-CFS was the only independent prognostic factor associated with postoperative CCI in this series. Frailty determined by CSHA-CFS is closely associated with the CCI, being a good predictor of postoperative complications in the elderly patient operated on by a major gastrointestinal procedure.