Frailty Index, Comprehensive Geriatric Assessment predict mortality in seniors after colorectal surgery

The 40-item Frailty Index (FI) and the Comprehensive Geriatric Assessment (CGA) are similarly predictive of 1-year mortality in elderly adults undergoing colorectal surgery, a recent study has found.

Researchers enrolled 99 elderly adults (mean age, 80.18±5.88 years; 62 percent male) who were scheduled to undergo elective gastrointestinal surgery. Geriatric assessment was performed 0–14 days before the procedure using the CGA and the 40-item FI. A Barthel Index telephone interview was administered after a year to assess long-term outcomes.

Colorectal cancer was the most prevalence diagnosis (88 percent), followed by gastric cancer (12 percent). More than half (63.6 percent) of the participants had deficits in more than three CGA domains and thus had a frail phenotype. The FI, in comparison, identified 50.5 percent as prefrail and 40.5 percent as frail.

Nineteen deaths were reported a year after surgery, resulting in a 1-year mortality rate of 19 percent. Receiver operating characteristic curve analysis revealed comparable capabilities of CGA (area under the curve [AUC], 0.72, 95 percent CI, 0.58–0.86) and FI (AUC, 0.70, 0.54–0.89; p=0.61) to predict mortality.

However, at a cutoff value of 0.19, FI showed a slight edge, with a sensitivity of 87.5 percent and specificity of 51.1 percent. CGA achieved its best predictive value at a threshold value of 3, where the sensitivity and specificity were 87.5 percent and 44.3 percent, respectively.

Multivariate logistic regression analysis identified decline in functional status (odds ratio [OR], 1.45, 95 percent CI, 1.03–2; p=0.033) and cancer stage (OR, 3.28, 0.91–11.8; p=0.069) as significant predictors of 1-year mortality.