Predictors of postoperative overall and severe complications after surgical treatment for endometrial cancer: The role of the fragility index

Objective To evaluate the predictive value of obesity, comorbidities, and fragility on overall and severe complication rate and survival among patients surgically treated for endometrial cancer. Methods Consecutive patients with endometrial cancer treated at the Royal Infirmary Hospital of Edinburgh...

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Published in:International journal of gynecology and obstetrics 2020-02, Vol.148 (2), p.174-180
Main Authors: Giannini, Andrea, Di Donato, Violante, Schiavi, Michele C., May, James, Panici, Pierluigi Benedetti, Congiu, Mario A.
Format: Article
Language:English
Subjects:
Aged
Comorbidity
Endometrial cancer
Endometrial Neoplasms - complications
Endometrial Neoplasms - surgery
Female
Fragility index
Frailty - complications
Frailty - epidemiology
Humans
Laparotomy - adverse effects
Logistic Models
Middle Aged
Odds Ratio
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Postoperative Period
Predictor of complications
Retrospective Studies
Surgical Treatment
Treatment Related Morbidity
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Summary:Objective To evaluate the predictive value of obesity, comorbidities, and fragility on overall and severe complication rate and survival among patients surgically treated for endometrial cancer. Methods Consecutive patients with endometrial cancer treated at the Royal Infirmary Hospital of Edinburgh from June 1, 2015, to June 30, 2017, were retrospectively enrolled in an observational study. Considering pre‐existing medical conditions, comorbidities, and complications, modified fragility index (mFI) was calculated. Logistic regression was used to evaluate predicting variables of overall (G1–G4) and severe (G3–G4) complication rate. Results One hundred patients were surgically treated for endometrial cancer. Elevated mFI >3 was related to a statistically higher access rate to the high dependency unit (HDU) or intensive care unit (ITU) (33.3% vs 6.6%, P=0.013). Overall, 31 women had postoperative complications. Using multivariate analysis, it was shown that undergoing laparotomy (odds ratio [OR] 7.06, 95% confidence interval [CI] 2.52–19.71; P3 (OR 7.19, 95% CI 1.43–36.25; P=0.021) were independent predictors of overall complications (G1–G4). Moreover, only smoking (OR 5.01, 95% CI 1.15–21.75; P=0.031) and mFI >3 (OR 5.16, 95% CI 1.07–24.94; P=0.047) were independent factors for severe complications (G3–G4). Conclusion Modified fragility index was an important predictor of complications among patients treated for endometrial cancer and could be a useful tool for assisting clinicians in perioperative management. Modified fragility index >3 is an important predictor of overall and severe complications among patients treated for endometrial cancer.
ISSN:0020-7292
1879-3479
DOI:10.1002/ijgo.13020