Risk Stratification Tool for Predicting Postoperative Outcomes in Patients Undergoing Esophagectomy: A Prospective Study - Abstract
Purpose: Frailty, a clinical syndrome characterized by a reduced physiological reserve and decreased resistance to stressors, is extremely common in oncology patients. Given that esophagectomy is associated with significant postoperative adverse outcomes, the early identification of high-risk patients is critical. This study compared the utility of the Modified 5-Factor Frailty Index (mFI-5) and the Modified Charlson Comorbidity Index (mCCI) in predicting postoperative outcomes in patients undergoing esophagectomy. Method: We reviewed the records of patients who underwent esophagectomy between 2019 and 2022. Two validated risk stratification tools measured the burden of comorbidity: mFI-5 and mCCI. The primary outcomes included a prolonged postoperative hospital stay and major and minor postoperative complications. Result: A total of 359 patients were included (mean age 63.1±8.6 years; 74.4% were males). The length of postoperative hospital stay was 30.0 (IQR 25.0, 39.5) days, with 37 patients (10.3%) experiencing major postoperative complications and 192 patients (53.5%) experiencing minor postoperative complications. In multivariate analysis, mCCI remained a significant predictor of major postoperative complications (OR=1.52, 95% CI 1.01–2.3, p=0.046), but was no longer a significant predictor of prolonged postoperative hospital stay or minor complications. In addition, the mFI-5 score was no longer a significant predictor of any of the three postoperative outcomes. Conclusion: This is the first study to compare the utility of the mFI-5 and mCCI in predicting adverse postoperative outcomes in patients undergoing esophagectomy. Our findings suggest that mCCI is a valid predictor of major complications in this patient group, whereas the role of mFI-5 is limited. This should be further investigated in a prospective multicenter cohort study.