The 5-item Modified Frailty Index Was Associated With Short-term Complications,30-day Mortality And Prognosis After Pancreaticoduodenectomy

Objective To study the relationship between 5-item frailty Modified index(5i-m FI)and short-term complications,30-day mortality and prognosis after panc reaticoduodenectomy(PD).Methods: The data of PD surgery in the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Bengbu Medical College from March 2017 to October2021 were retrospectively collected,and 269 patients met the research requirements.The clinical data of the patients were collected(preoperative general data,intraoperative conditions,postoperative recovery,etc.).According to the scores of hypertension,diabetes,chronic obstructive pulmonary disease,congestive heart failure and dependent functional state variables in the 5i-m FI score,each variable was scored 1 point.The patients were divided into non-frail group(5i-m FI = 0,1)and frail group(5i-m FI ≥ 2)by 5i-m FI score.To explore the relationship between 5i-m FI score and postoperative complications and 30-day death.Logistic regression analysis was used to analyze the risk factors of postoperative complications and 30-day death.The area under the receiver operating characteristic curve(AUC)was used to calculate the discrimination ability of 5i-m FI score with age,body mass index and American Society of Anesthesiologists(ASA)classification for short-term postoperative efficacy.Kaplan-Meier and Log Rank test were used to analyze the postoperative survival of the two groups.Results Of the 269 patients,55 patients were included in the frailty group(20.4 %)and 214 patients were included in the non-frailty group(79.6 %).The incidence of minor complications,major complications,any complications and death in the frailty group within 30 days was significantly higher than that in the non-frailty group(P < 0.05).The probability of complications and death gradually increased with the increase of 5i-m FI index,and the difference was statistically significant(P <0.01).There were significant differences in the incidence of postoperative pancreatic fistula,delayed gastric emptying,chylous fistula,biliary fistula,pulmonary complications,cardiac complications and deep vein thrombosis between the two groups(P < 0.05).Multivariate Logistic regression analysis showed that 5i-m FI was an independent risk factor for grade B / C pancreatic fistula,delayed gastric emptying,biliary fistula,major complications and 30-day death after pancreaticoduodenectomy(P < 0.05).By comparing the area under the receiver operating characteristic curve(AUC),5i-m FI had a better predictive ability for short-term postoperative complications(OR 0.843,95 % CI : 0.784-0.903;p < 0.05).The overall survival time of the frailty group was lower than that of the non-frailty group(P < 0.05).Conclusion Compared with more commonly available and easier to implement indicators such as age,ASA grade,and body mass index,the 5i-m FI score has stronger predictive performance for short-term complications,30-day death,and prognosis in patients after PD.The 5i-m FI score is a more comprehensive,more concise,and more suitable clinical scoring tool,which is a recommended scoring standard.