Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery

• Published in: Journal of surgical oncology Vol. 126; no. 2; pp. 372 - 382
• Main Authors: Cooper, Lisa, Gong, Yusi, Dezube, Aaron R., Mazzola, Emanuele, Deeb, Ashley L., Dumontier, Clark, Jaklitsch, Michael T., Frain, Laura N.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-08-2022
• Subjects: Aged; comprehensive geriatric assessment; Frail Elderly; Frailty; Frailty - complications; Geriatric Assessment; Geriatrics; Humans; Lung cancer; Lung Neoplasms - complications; Lung Neoplasms - surgery; Postoperative Complications - epidemiology; Thoracic Surgery; lung cancer; frailty; comprehensive geriatric assessment; thoracic surgery
• ISSN: 0022-4790; 1096-9098; 1096-9098
• DOI: 10.1002/jso.26866

Background and Objectives
We assessed frailty, measured by a comprehensive geriatric assessment‐based frailty index (FI‐CGA), and its association with postoperative outcomes among older thoracic surgical patients.
Methods
Patients aged ≥65 years evaluated in the geriatric‐thoracic clinic between June 2016 through May 2020 who underwent lung surgery were included. Frailty was defined as FI‐CGA > 0.2, and "occult frailty", a level not often recognized by surgical teams, as 0.2 < FI‐CGA < 0.4. A qualitative analysis of geriatric interventions was performed.
Results
Seventy‐three patients were included, of which 45 (62%) were nonfrail and 28 (38%) were frail. “Occult frailty” was present in 23/28 (82%). Sixty‐one (84%) had lung malignancy. Geriatric interventions included delirium management, geriatric‐specific pain and bowel regimens, and frailty optimization. More sublobar resections versus lobectomies (61% vs. 25%) were performed among frail patients. Frailty was not significantly associated with overall complications (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 0.88–6.44; p = 0.087), major complications (OR: 2.33; 95% CI: 0.48–12.69; p = 0.293), discharge disposition (OR: 2.8; 95% CI: 0.71–11.95; p = 0.141), or longer hospital stay (1.3 more days; p = 0.18).
Conclusion
Frailty and “occult frailty” are prevalent in patients undergoing lung surgery. However, with integrated geriatric management, these patients can safely undergo surgery.