SpringerLink
Log in

Comparison of Modified Frailty Index, Clinical Frailty Scale, ECOG Score, and ASA PS Score in Predicting Postoperative Outcomes in Cancer Surgery: A Prospective Study

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Multiple pre-operative risk assessment scores are available for risk stratification of cancer patients undergoing surgery. This is the first study comparing commonly used preoperative risk assessment tools of Eastern Cooperative Oncology Group Performance Scale (ECOG) and American Society of Anaesthesiologists Physical Status Scale (ASA PS) with frailty scores of Modified Frailty Index (MFI) and Clinical Frailty Scale (CFS). This is a prospective observational study of adult cancer patients undergoing oncosurgery in a tertiary cancer center over one year. Pre-operative risk stratification was done using CFS, MFI, ASA PS, and ECOG scales. All patients were followed up postoperatively for 30 days, and complications were documented. Univariate and multivariate analyses were performed. p value of ≤0.05 was considered significant. Of the 4107 patients studied, 12.6% had prolonged hospitalization, 6.1% had morbidity, 0.9% had readmission, and mortality was 0.6%. ASA PS, ECOG, and CFS were significantly associated with prolonged hospitalization, morbidity, and mortality. MFI was significantly associated with prolonged hospitalization and morbidity. No score could predict readmission. On multivariate analysis, morbidity and readmission were significantly associated with neoadjuvant therapy (p=0.001), mortality with emergency surgery (p=0.001), and prolonged hospitalization with stage III and IV cancer (p=0.001). In adult patients undergoing oncosurgery, ASA PS, ECOG, and CFS are predictors of prolonged hospitalization, morbidity, and mortality. MFI is predictive of prolonged hospitalization and morbidity. None of the studied pre-operative risk scores predict readmission. Newer predictive tools with cancer-specific factors are required for better risk stratification of cancer patients undergoing surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–49

    Article  PubMed  Google Scholar 

  2. ASA (2005), Relative Value Guide. https://www.asahq.org/clinical/physicalstatus.htm. Accessed 23 Apr 2023

  3. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649–55

    Article  CAS  PubMed  Google Scholar 

  4. Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K (2002) Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr 27(2):1. https://doi.org/10.1186/1471-2318-2-1

    Article  Google Scholar 

  5. Ethun CG, Bilen MA, Jani AB, Maithel SK, Ogan K, Master VA (2002) Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA Cancer J Clin 67(5):362–377. https://doi.org/10.3322/caac.21406

    Article  Google Scholar 

  6. Jauhari Y, Gannon MR, Dodwell D, Horgan K, Tsang C, Clements K, Medina J, Tang S, Pettengell R, Cromwell DA (2020) Addressing frailty in patients with breast cancer: a review of the literature. Eur J Surg Oncol 46(1):24–32. https://doi.org/10.1016/j.ejso.2019.08.011

    Article  PubMed  Google Scholar 

  7. Hogan DB, MacKnight C, Bergman H (2003) Steering Committee, Canadian Initiative on Frailty and Aging. Models, definitions, and criteria of frailty. Aging Clin Exp Res 15(3 Suppl):1–29

    PubMed  Google Scholar 

  8. Tsiouris A, Hammoud ZT, Velanovich V, Hodari A, Borgi J, Rubinfeld I et al (2013) A modified Frailty Index to assess morbidity and mortality after lobectomy. J Surg Res 183(1):40–46. https://doi.org/10.1016/j.jss.2012.11.059

    Article  PubMed  Google Scholar 

  9. Farhat JS, Velanovich V, Falvo AJ, Horst HM, Swartz A, Patton JH Jr, Rubinfeld IS (2012) Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg 72(6):1526–30. https://doi.org/10.1097/TA.0b013e3182542fab. (discussion 1530-1)

    Article  PubMed  Google Scholar 

  10. Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173(5):489–495. https://doi.org/10.1503/cmaj.050051

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT et al (2014) Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 186(2):E95-102. https://doi.org/10.1503/cmaj.130639

    Article  PubMed  PubMed Central  Google Scholar 

  12. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf. Accessed 15 Mar 2023

  13. Hanna TP, King WD, Thibodeau S, Jalink M, Paulin GA, Harvey-Jones E (2020) Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ 371:m4087. https://doi.org/10.1136/bmj.m4087

    Article  PubMed  Google Scholar 

  14. Ho PJ, Cook AR, Binte Mohamed Ri NK, Liu J, Li J, Hartman M (2020) Impact of delayed treatment in women diagnosed with breast cancer: a population-based study. Cancer Med 9(7):2435–2444. https://doi.org/10.1002/cam4.2830

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Young J, Badgery-Parker T, Dobbins T, Jorgensen M, Gibbs P, Faragher I et al (2015) Comparison of ECOG/WHO performance status and ASA score as a measure of functional status. J Pain Symptom Manage 49(2):258–64

    Article  PubMed  Google Scholar 

  16. Simcock R, Wright J (2020) Beyond Performance Status. Clin Oncol (R Coll Radiol) 32(9):553–561. https://doi.org/10.1016/j.clon.2020.06.016

    Article  CAS  PubMed  Google Scholar 

  17. Montroni I, Ugolini G, Saur NM, Rostoft S, Spinelli A, Van Leeuwen BL et al (2022) Quality of life in older adults after major cancer surgery: the GOSAFE International Study. J Natl Cancer Inst 114(7):969–978. https://doi.org/10.1093/jnci/djac071

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gu C, Lu A, Lei C, Wu Q, Zhang X, Wei M, Wang Z et al (2022) Frailty index is useful for predicting postoperative morbidity in older patients undergoing gastrointestinal surgery: a prospective cohort study. BMC Surg 22(1):57. https://doi.org/10.1186/s12893-022-01471-9

    Article  PubMed  PubMed Central  Google Scholar 

  19. Vermillion SA, Hsu FC, Dorrell RD, Shen P, Clark CJ (2017) Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients. J Surg Oncol 115(8):997–1003. https://doi.org/10.1002/jso.24617

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pichatechaiyoot A, Thannil S, Boonyapipat S, Buhachat R (2022) Preoperative modified frailty index to predict surgical complications in endometrial cancer patients. ObstetGynecol Sci 65(6):513–521. https://doi.org/10.5468/ogs.22140

    Article  Google Scholar 

  21. Hewitt J, Carter B, McCarthy K, Pearce L, Law J, Wilson FV et al (2019) Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing 48(3):388–394. https://doi.org/10.1093/ageing/afy217

    Article  CAS  PubMed  Google Scholar 

  22. Hewitt J, Long S, Carter B, Bach S, McCarthy K, Clegg A (2018) The prevalence of frailty and its association with clinical outcomes in general surgery: a systematic review and meta-analysis. Age Ageing 47(6):793–800. https://doi.org/10.1093/ageing/afy110

    Article  PubMed  Google Scholar 

  23. Cihoric M, Tengberg LT, Foss NB, Gögenur I, Tolstrup MB, Bay-Nielsen M (2020) Functional performance and 30-day postoperative mortality after emergency laparotomy-a retrospective, multicenter, observational cohort study of 1084 patients. Perioper Med (Lond) 9:13. https://doi.org/10.1186/s13741-020-00143-7

    Article  PubMed  Google Scholar 

  24. Gattani S, Ramaswamy A, Noronha V, Castelino R, Kumar S, Abhijith R et al (2022) ECOG performance status as a representative of deficits in older Indian patients with cancer: a cross-sectional analysis from a large cohort study. Cancer Res Statistics Treat 5(2):256–262. https://doi.org/10.4103/crst.crst_127_22

    Article  Google Scholar 

  25. Rosa F, Tortorelli AP, Quero G, Galiandro F, Fiorillo C, Sollazzi L, Alfieri S (2019) The impact of preoperative ASA-physical status on postoperative complications and long-term survival outcomes in gastric cancer patients. Eur Rev Med Pharmacol Sci 23(17):7383–7390. https://doi.org/10.26355/eurrev_201909_18846

    Article  CAS  PubMed  Google Scholar 

  26. Shahid RK, Ahmed S, Le D, Yadav S (2021) Diabetes and cancer: risk, challenges, management and outcomes. Cancers (Basel) 13(22):5735. https://doi.org/10.3390/cancers13225735

    Article  CAS  PubMed  Google Scholar 

  27. Lange SA, Reinecke H (2022) Coronary artery disease and cancer: treatment and prognosis regarding gender differences. Cancers (Basel) 14(2):434. https://doi.org/10.3390/cancers14020434

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Services, Regional Cancer Centre Thiruvananthapuram (Trivandrum), Medial College Complex, Kerala, 695011, India

    Rexeena Bhargavan, Paul Augustine & Shaji Thomas

  2. Department of Anaesthesiology, Regional Cancer Centre Thiruvananthapuram (Trivandrum), Medial College Complex, Kerala, 695011, India

    Frenny Ann Philip

  3. Department of Epidemiology and Biostatistics, Regional Cancer Centre Thiruvananthapuram (Trivandrum), Medial College Complex, Kerala, 695011, India

    Jagathnath Krishna KM

Authors
  1. Rexeena Bhargavan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frenny Ann Philip
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jagathnath Krishna KM
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul Augustine
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shaji Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frenny Ann Philip.

Ethics declarations

Ethics Approval

The study was cleared by the Institutional Review Board of our Cancer Centre (IRB No. 01/2018/03).

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bhargavan, R., Philip, F.A., KM, J.K. et al. Comparison of Modified Frailty Index, Clinical Frailty Scale, ECOG Score, and ASA PS Score in Predicting Postoperative Outcomes in Cancer Surgery: A Prospective Study. Indian J Surg Oncol (2024). https://doi.org/10.1007/s13193-024-01995-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13193-024-01995-x

Keywords

Search

Navigation