K. Kittur2, J. Ngo2, C. C. Moodie1, J. R. Garrett1, K. Dillen1, J. R. Tew1, J. J. Baldonado1,2, J. P. Fontaine1,2, E. M. Toloza1,2 1Moffitt Cancer Center, Thoracic Oncology, Tampa, FL, USA 2University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
Introduction: The Modified 5-Item Frailty Index (mFI-5) is a comorbidity-based prognostic scoring system that has been demonstrated as an effective predictive tool of surgical outcomes and complications across multiple subspecialties. The objective of this study is to determine the predictive value of mFI-5 for perioperative outcomes following robotic-assisted pulmonary lobectomy (RAPL) for lung cancer.
Methods: We retrospectively analyzed 489 patients who underwent RAPL from January 2014 to March 2022 by one surgeon. Five factors compose the mFI-5: functionally-dependent health status, hypertension, chronic obstructive pulmonary disease, congestive heart failure, and diabetes mellitus. Patients were stratified into 3 groups: mFI-5 = 0 (n = 155, 32%), mFI-5 = 1 (n = 231, 47%), or mFI-5 ≥ 2 (n = 103, 21%). Associations between mFI-5 and demographic, clinical, and outcome parameters were assessed using comparative and multivariable analyses. Statistical significance was set at p≤0.05.
Results: Patients with a mFI-5 score ≥2 were on average older (72.0 ± 0.7 yr; p<0.001) and had higher body mass index (BMI; 29.1 ± 0.6 kg/m2; p<0.001), larger proportion of males (57/103, 55.3%; p=0.012), greater estimated blood loss (EBL; 125 mL [50, 300]; p=0.031), longer chest tube duration (4 d [3, 7]; p=0.017), and longer hospital length of stay (LOS; 5 d [3, 7]; p=0.003). Multivariable analyses demonstrated a mFI-5 score ≥2 as a significant independent predictor of EBL (Odds Ratio [OR] = 1.426; 95% confidence interval [CI] = 1.400–1.452; p<0.001), chest tube duration (OR = 1.193; 95%CI = 1.069–1.332; p=0.002), and hospital LOS (OR = 1.263; 95%CI = 1.127–1.415; p<0.001) (Table 1).
Conclusions: The mFI-5 score has significant predictive value for perioperative outcomes in patients undergoing RAPL. The mFI-5 score is a tool that surgeons can consider preoperatively to identify patients at risk for increased estimated blood loss, chest tube duration, and hospital length of stay.
