Association of frailty with perioperative and survival outcomes in patients with gynecologic cancers: a population-based study

Objectives — The relationship between frailty and both short- and long-term outcomes remains underexplored in gynecologic oncology (GO). We sought to evaluate the association of frailty with 30-day complications, costs and mortality, and long-term survival following surgery.

Methods — A population-based observational retrospective cohort study of patients undergoing a laparotomy for a gynecologic malignancy between 2009 and 2021 was conducted using Ontario province-wide databases. Frailty was defined using the preoperative frailty index (pFI) and the John Hopkins Adjusted Clinical Groups frailty indicator (ACG).

Results — Among 21,359 patients, 1405 (6.6 %) and 1144 (5.4 %) were frail using the pFI and ACG.
Frailty as assessed by the pFI was associated with an increased risk of 30-daycomplications (25.7 % vs 7.4 %, p < 0.0001), 30-day mortality (2.9 % vs 0.5 %, p < 0.0001), 90-day mortality (7.1 % vs 1.4 %, p < 0.0001), 30-day mean healthcare costs ($16,478 vs $9306, p < 0.0001), and lower median 5 year-survival (3.28 years versus not reached).

Frailty was independently associated with 30-day complications (OR 1.92, 95 % CI 1.63–2.27, p < 0.0001)) in multivariable regression analysis adjusting for age, income quintile, primary cancer, stage, type of surgery and neoadjuvant chemotherapy, and with lower 5-year survival (HR 1.27, 95 % CI 1.16–1.38, p < 0.0001) adjusting for age, primary cancer, stage, neoadjuvant chemotherapy and comorbidities.
Results for these outcomes were similar using the ACG. The ROC analysis revealed similar area under the curve for both indices.

Conclusions — Frailty as measured by both the pFI and ACG was predictive of outcomes including increased postoperative morbidity and mortality, and 5-year survival. Strategies to optimize perioperative care for frailty are required.