Modified Frailty Index for Minimally Invasive Distal Pancreatectomy
Condition: Postoperative Complication
MeSH terms: Frailty; Postoperative Complications
Study type: Observational

Summary: 
      This study aims to investigate the difference in postoperative complications according to the
      modified Frailty Index (mFI) in patients who underwent minimally invasive distal
      pancreatectomy for pancreatic tumors at the Asan Medical Center's Department of
      Hepato-Biliary-Pancreatic Surgery from 2005 to 2019. It also seeks to confirm the utility of
      mFI as a predictive factor for postoperative complications in frail patients in the future.
    

Detailed description: 
      Distal pancreatectomy is a surgery performed to treat tumors in the distal pancreas. The
      minimally invasive approach to this surgery has become the standard due to its shorter
      hospital stay, quicker recovery, less pain, and similar complication rates compared to open
      surgery, especially for benign tumors. In selected patients with malignant tumors, minimally
      invasive distal pancreatectomy has gradually expanded to a state where it is not inferior to
      open surgery in terms of postoperative complications and long-term prognosis. As the average
      lifespan increases, elderly patients with comorbidities are steadily increasing in numbers
      among those who undergo distal pancreatectomy. However, predicting postoperative
      complications and mortality rates for these patients is still difficult. Simple yet effective
      predictive factors for postoperative complications are needed. The Canadian Study of Health
      and Aging has created a standardized frailty index (CSHA-FI) as a tool for predicting frailty
      in elderly patients, and a modified Frailty Index (mFI) has been developed for easy use. The
      mFI has been reported as a predictor of postoperative morbidity and mortality rates after
      colorectal and vascular surgery. This study aims to investigate whether mFI can be used as a
      predictive factor for postoperative morbidity and mortality rates in patients who undergo
      minimally invasive distal pancreatectomy and to utilize it for clinical treatment in the
      future.
    

Intervention name(s): Modified frailty index
Intervention type(s): Behavioral
Intervention description(s): The mFI includes the following 11 items from the National Surgical Quality Improvement Program (NSQIP): diabetes; functional status (not independent); chronic obstructive pulmonary disease (COPD) or pneumonia; congestive heart failure; history of myocardial infarction; hypertension requiring medication; peripheral vascular disease or rest pain; impaired sensorium; history of either transient ischemic attack or cerebrovascular accident; history of cerebrovascular accident with neurologic deficit; and prior percutaneous coronary intervention, previous coronary surgery, or history of angina.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        This study aims to investigate the trend of frailty among patients who underwent minimally
        invasive pancreaticoduodenectomy for pancreatic head tumors between January 2005 and
        December 2019, using data collected until October 31, 2022. Based on an estimated 150
        surgeries per year, the sample size is expected to be around 2000 patients. Frailty will be
        defined as mFI of 0.27 or higher, with an estimated prevalence of 3% among this patient
        population. The study will analyze the differences and severity of postoperative
        complications between frail and non-frail patients, while also examining the trend of
        frailty over the 15-year period. The expected sample size for the study is around 2000
        patients.