Frailty Assessment for Risk Stratification in Pancreatic Surgery – Results of a Single-Center Cohort Study

Abstract Background Large cohort studies found an increase in frailty with age. Age is a known risk factor for pancreatic cancer. Seventy percent of new diagnoses are made in patients aged more than 65 years. Pancreatic resections represent the only hope for cure but are associated with high morbidity. The definition “fit for pancreatic surgery”, currently mainly based on age and comorbidities, is continuously challenged. Aims The aim of this study is to analyze the impact of frailty on postoperative outcomes after pancreatic resections. Methods Data of consecutive patients undergoing pancreatic resections between January 2015 and July 2022 were retrospectively analyzed. Postoperative complications were graded by the Clavien-Dindo Classification, Comprehensive Complication Index (CCI) and complications specific to pancreatic resections as recommended and published by the International Study Group of Pancreatic Surgery. The modified frailty index (mFI) was defined by 11 variables. An mFI score above 0.27 was set to define frailty. Results A pancreatic resection was performed in 159 patients, of which 23 (15%) were classified as frail. Pancreatoduodenectomies were similarly distributed in both groups. Frail patients were older (median of 74 vs. 69 years). Male gender was associated with frailty (83%, p=0.001)., Moreover, frailty was associated with an increased rate of preoperative biliary drainage. Although intensive care stay was increased in the frail group (median 3 vs. 0 days; p=0.01), total length of hospital stay was not affected. Frailty was associated with severe complications as defined by a comprehensive complication index 50 (35% vs. 10%; p=0.003), an increased rate of severe type C pancreatic fistula (13% vs. 2%, p=0.04), and a higher 90-day mortality (13% vs. 2%, p=0.04). Conclusion Assessment of frailty should be used for preoperative risk stratification since frailty is associated with a higher morbidity and mortality after pancreatic resections.