| Objective “Frailty” is a marker of physiological decline of multiple organ systems.A series of frailty scales were gradually applied to evaluate perioperative patients to predict the correlation between preoperative frailty assessment and postoperative outcome.However,an optimal tool for assessing perioperative frailty in disparate patients and for surgeries has not yet been identified.The aim of this study is to evaluate the effect of Tilburg Frailty Indicator(TFI)on postoperative recovery quality gynecological cancer patients,and evaluate the correlation between frailty and postoperative quality of recovery,postoperative complications and length of hospital stay.Methods A prospective cohort study is conducted of 200 patients scheduled for radical gynecological cancer surgery at a large hospital from May 2021 to January 2022.TFI was used to assess the degree of preoperative frailty,and patients were divided into two groups based on the preoperative TFI score: frail group(≥5 points)and non-frail group(<5 points).We collected preoperative Qo R-15 scores as baseline data.All patients were re-examined on the 3rd and 5th days and 1 month after surgery.In this study,the postoperative quality of recovery was defined as “good” or “not good”(total points ≥ 121 or < 121).Demographic data,preoperative hemoglobin,albumin levels,surgical and anesthesia records,and postoperative complications were also collected.Our primary outcome was the postoperative quality of recovery based on the Qo R-15,and the secondary outcomes were postoperative complications and length of hospital stay.Multiple logistic regression was used to examine the relationship between frailty and outcomes.We developed receiver operating characteristic curve(ROC)and assessed areas under the ROC(AUC)to explore the ability of frailty to predict postoperative recovery quality.Results Overall 169 patients were enrolled(median age 53 years,range 29–85years).In this group of gynecologic cancer patients,the prevalence of frailty based on TFI was47.9%.Frail patients were significantly older than non-frail patients with a median age of 55 years compared to 51years(P?0.05).Frail patients had higher ASA(American Society of Anesthesiologists physical status classification system)score,with 95.1%(n=77)patients being classified as either ASA III or IV,compared to 86.4%(n=76)of non-frail patients(P=0.009).Within 30 days of surgery,37 patients(21.9%)experienced postoperative complications with the Clavien-Dindo criteria ≥Ⅱ.Frail patients,35.8%had complications with the Clavien-Dindo criteria ≥ Ⅱ,compared to 9.1% of the non-frail patients(P<0.001).Frail patients were more likely to suffer from higher complication.In the multivariate regression analysis,frailty emerged as a significant predictor of the 3-day Qo R-15 score(a OR = 11.69;95% CI,4.26-32.08;P?0.001)and complications(a OR = 10.05;95% CI,1.66-60.72;P=0.012).Frailty was not associated with length of stay(a OR = 2.12;95% CI,0.87-5.16;P=0.099).The combination of the TFI,ASA classification,and types of cancer resulted in an increase in the AUC compared with the TFI alone(AUC: 0.796 [95% CI,0.727-0.865],P?0.05].Conclusion The use of the TFI may assist surgeons in estimating the risk with respect to postoperative quality of recovery and complications in gynecologic cancer patients.Frailty assessment using TFI can be used perioperative in patients with gynecological cancer.Combining the TFI with ASA classification and cancer type is expected to improve the predictive ability of poor recovery quality. |
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