The Role of Frailty and ASA Classification in Perioperative Risk Stratification for Esophagectomy Patients: A Decade-Long Retrospective Study.

Abstract

Purpose: To evaluate perioperative risk factors and the predictive accuracy of the modified frailty index (mFI-5) and American Society of Anesthesiologists' Physical Status (ASA-PS) classification in predicting high morbidity following esophagectomy.

Design: Retrospective study.

Methods: Predictors of high morbidity were identified using logistic regression, and the performance of mFI-5 and ASA-PS scores was assessed using receiver operating characteristic curves.

Findings: The high-morbidity rate was 48%. Significant predictors included ASA greater than or equal to 3, preoperative chemoradiotherapy, and prolonged Intensive Care Unit (ICU) and hospital stays. The ASA-PS classification offered better overall accuracy in predicting morbidity. While the mFI-5 showed high sensitivity, it exhibited poor specificity, resulting in a high false-positive rate.

Conclusions: Both mFI-5 and ASA-PS have limitations in predicting high morbidity after esophagectomy. However, a model that integrates various perioperative factors, particularly postoperative variables, demonstrated significance.