Li Yunsong, Peng Chunwei, Zou Bingbing
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Australas J Ageing. 2025 Mar;44(1):e70012. doi: 10.1111/ajag.70012.
Frailty is associated with postoperative complications in older people with gastrointestinal malignancies. However, the relationship between frailty and complication severity, as well as the risk factors for complications after radical surgery, is still unclear.
Frailty was assessed using a modified Frailty Index (mFI) score, and the correlation between frailty and postoperative complications was compared between frail and non-frail groups. Complication severity was evaluated using the Clavien-Dindo (C-D) system, and independent risk factors for postoperative complications were identified through odds ratios (OR) using multivariate logistic analysis. The participants were divided into non-frailty and frailty groups based on the mFI.
The frailty group had fewer patients aged 60-69 years (19% vs. 31%, p = .03) and a higher incidence of moderate CCI (52% vs. 69%, p = .001). Frailty was strongly linked to postoperative complications, including pulmonary infections (16% vs. 8%, p = .009), pulmonary embolism (8% vs. 3%, p = .02) and acute kidney injury (14% vs. 6%, p = .005). Older frail patients experienced more severe complications, with higher rates of C-D grade III (23% vs. 10%, p = .004) and grade V (6% vs. 1%, p = .004). Multivariate analysis found that frailty (OR: 1.492, p = .02), age greater than 70 years (OR: 1.239, p = .04) and severe comorbidities increased the OR of severe complications. Additionally, frail patients had poorer recovery, with higher in-hospital mortality (4% vs. 0%, p = .01), more ICU readmissions (11% vs. 3%, p = .005), longer stays (9 vs. 8 days, p < .001) and higher costs (48,035 RMB vs. 43,792 RMB, p < .001).
Older frail adults experienced more severe complications and had worse postoperative recovery.
衰弱与老年胃肠道恶性肿瘤患者术后并发症相关。然而，衰弱与并发症严重程度之间的关系以及根治性手术后并发症的危险因素仍不清楚。
使用改良衰弱指数（mFI）评分评估衰弱情况，并比较衰弱组和非衰弱组中衰弱与术后并发症之间的相关性。使用Clavien-Dindo（C-D）系统评估并发症严重程度，并通过多因素逻辑分析使用比值比（OR）确定术后并发症的独立危险因素。根据mFI将参与者分为非衰弱组和衰弱组。
衰弱组60 - 69岁的患者较少（19%对31%，p = 0.03），中度CCI的发生率较高（52%对69%，p = 0.001）。衰弱与术后并发症密切相关，包括肺部感染（16%对8%，p = 0.009）、肺栓塞（8%对3%，p = 0.02）和急性肾损伤（14%对6%，p = 0.005）。老年衰弱患者经历的并发症更严重，C-D III级（23%对10%，p = 0.004）和V级（6%对1%，p = 0.004）的发生率更高。多因素分析发现，衰弱（OR：1.492，p = 0.02）、年龄大于70岁（OR：1.239，p = 0.04）和严重合并症会增加严重并发症的OR。此外，衰弱患者恢复较差，住院死亡率较高（4%对0%，p = 0.01），再次入住ICU的比例更高（11%对3%，p = 0.005），住院时间更长（9天对8天，p < 0.001），费用更高（48,035元对43,792元，p < 0.001）。
老年衰弱成年人经历的并发症更严重，术后恢复更差。
