title: Old or frail: what tells us more? Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer Frailty as a predictor of surgical outcomes in older patients. Impact of preoperative hand grip strength on morbidity following gastric cancer surgery Redefining Geriatric Preoperative Assessment Using Frailty, Disability and Co-Morbidity Sarcopenia Adversely Impacts Postoperative Clinical Outcomes Following Gastrectomy in Patients with Gastric Cancer: A Prospective Study
abstract: BACKGROUND Selecting elderly persons who need geriatric interventions  and making accurate treatment decisions are recurring challenges in geriatrics . Chronological age , although often used , does not seem to be the best selection criterion . Instead , the concept of frailty , which indicates several concurrent losses in re sources , can be used . METHODS The predictive values of chronological age and frailty were investigated in a large community sample of persons aged 65 years and older , r and omly drawn from the register of six municipalities in the northern regions of the Netherl and s ( 45 % of the original addressees ) . The participants ' generative capacity to sustain well-being ( i.e. , self-management abilities ) was used as the main outcome measure . RESULTS When using chronological age instead of frailty , both too many and too few persons were selected . Furthermore , frailty related more strongly ( with beta values ranging from -.25 to -.39 ) to a decline in the participants ' self-management abilities than did chronological age ( with beta values ranging from -.06 to -.14 ) . Chronological age added very little to the explained variances of all outcomes once frailty was included . CONCLUSIONS Using frailty as the criterion to select older persons at risk for interventions may be better than selecting persons based only on their chronological age Abstract Currently , the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated . Moreover , the association between sarcopenia and postoperative complications remains controversial . This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer . From December 2008 to April 2013 , the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospect ively . Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis . Skeletal muscle mass was determined by abdominal ( computed tomography ) CT scan , and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification . Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed . A total of 937 patients were included in this study , and 389 ( 41.5 % ) patients were sarcopenic based on the diagnostic cut-off values ( 34.9 cm2/m2 for women and 40.8 cm2/m2 for men ) . Sarcopenia was an independent risk factor for severe postoperative complications ( OR = 3.010 , P < 0.001 ) , but not for total complications . However , sarcopenia did not show significant association with operative mortality . Moreover , sarcopenia was an independent predictor for poorer overall survival ( HR = 1.653 , P < 0.001 ) and disease-free survival ( HR = 1.620 , P < 0.001 ) . Under the adjusted tumor-node-metastasis ( TNM ) stage , sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III , but not in patients with TNM stage I.Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer . Moreover , sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III , but not in patients with TNM stage BACKGROUND Preoperative risk assessment is important yet inexact in older patients because physiologic reserves are difficult to measure . Frailty is thought to estimate physiologic reserves , although its use has not been evaluated in surgical patients . We design ed a study to determine if frailty predicts surgical complications and enhances current perioperative risk models . STUDY DESIGN We prospect ively measured frailty in 594 patients ( age 65 years or older ) presenting to a university hospital for elective surgery between July 2005 and July 2006 . Frailty was classified using a vali date d scale ( 0 to 5 ) that included weakness , weight loss , exhaustion , low physical activity , and slowed walking speed . Patients scoring 4 to 5 were classified as frail , 2 to 3 were intermediately frail , and 0 to 1 were nonfrail . Main outcomes measures were 30-day surgical complications , length of stay , and discharge disposition . Multiple logistic regression ( complications and discharge ) and negative binomial regression ( length of stay ) were done to analyze frailty and postoperative outcomes associations . RESULTS Preoperative frailty was associated with an increased risk for postoperative complications ( intermediately frail : odds ratio [ OR ] 2.06 ; 95 % CI 1.18 - 3.60 ; frail : OR 2.54 ; 95 % CI 1.12 - 5.77 ) , length of stay ( intermediately frail : incidence rate ratio 1.49 ; 95 % CI 1.24 - 1.80 ; frail : incidence rate ratio 1.69 ; 95 % CI 1.28 - 2.23 ) , and discharge to a skilled or assisted-living facility after previously living at home ( intermediately frail : OR 3.16 ; 95 % CI 1.0 - 9.99 ; frail : OR 20.48 ; 95 % CI 5.54 - 75.68 ) . Frailty improved predictive power ( p < 0.01 ) of each risk index ( ie , American Society of Anesthesiologists , Lee , and Eagle scores ) . CONCLUSIONS Frailty independently predicts postoperative complications , length of stay , and discharge to a skilled or assisted-living facility in older surgical patients and enhances conventional risk models . Assessing frailty using a st and ardized definition can help patients and physicians make more informed decisions Background Sarcopenia is a decrease in both muscle mass and strength . It remains unclear whether sarcopenia is associated with morbidity after gastric cancer surgery . This study evaluated the impact of sarcopenia on the morbidity of gastric cancer surgery . Methods A total of 293 gastric cancer patients who underwent curative surgery between May 2011 and June 2013 were retrospectively examined . Patients with performance status 3 or 4 were excluded .  Preoperative lean body mass ( LBM ) was evaluated by bioelectrical impedance analysis and expressed as LBM index .  Preoperative muscle function was measured by h and grip strength ( HGS ) . The cutoff values were the gender-specific lowest 20 % . Grade 2 or higher morbidities , as retrospectively evaluated by the Clavien – Dindo classification , were obtained from the patient record . The risk factors for morbidity were examined by univariate and multivariate analyses . Results Morbidity was observed in 39 patients ( 13.3 % ) , including 7 with pancreatic leakage , 12 with anastomotic leakage , and 4 with intraabdominal abscesses , but no mortality was observed . The univariate analysis showed that male gender , total gastrectomy , splenectomy , and a low HGS were significant risk factors for morbidity . A low LBM was not a significant risk factor . A low HGS , male gender , and total gastrectomy remained significant in the multivariate analysis . Conclusions A low h and grip strength was a significant risk factor for morbidity after gastric cancer surgery . The importance of the h and grip strength as a risk factor should be examined in future prospect i ve studies Objectives : ( 1 ) Determine the relationship of geriatric assessment markers to 6-month postoperative mortality in elderly patients . ( 2 ) Create a clinical prediction rule using geriatric markers from preoperative assessment . Background : Geriatric surgery patients have unique physiologic vulnerability requiring preoperative assessment beyond the traditional evaluation of older adults . The constellation of frailty , disability and comorbidity predict poor outcomes in elderly hospitalized patients . Methods : Prospect ively , subjects ≥65 years undergoing a major operation requiring postoperative intensive care unit admission were enrolled . Preoperative geriatric assessment s included  : Mini-Cog Test ( cognition ) , albumin , having fallen in the past 6-months , hematocrit , Katz Score ( function ) , and Charlson Index ( comorbidities )  . Outcome measures included 6-month mortality ( primary ) and postdischarge institutionalization ( secondary ) . Results : One hundred ten subjects ( age 74 ± 6 years ) were studied . Six-month mortality was 15 % ( 16/110 ) . Preoperative markers related to 6-month mortality included : impaired cognition ( P < 0.01 ) , recent falls ( P < 0.01 ) , lower albumin ( P < 0.01 ) , greater anemia ( P < 0.01 ) , functional dependence ( P < 0.01 ) , and increased comorbidities ( P < 0.01 ) . Similar statistical relationships were found for all 6 markers and postdischarge institutionalization . Logistic regression identified any functional dependence ( odds ratio 13.9 ) as the strongest predictor of 6-month mortality . Four or more markers in any one patient predicted 6-month mortality with a sensitivity of 81 % ( 13/16 ) and specificity of 86 % ( 81/94 ) . Conclusions : Geriatric assessment markers for frailty , disability and comorbidity predict 6-month postoperative mortality and postdischarge institutionalization . The preoperative presence of ≥4 geriatric-specific markers has high sensitivity and specificity for 6-month mortality . Preoperative assessment using geriatric-specific markers is a substantial paradigm shift from the traditional preoperative evaluation of older adults Background Sarcopenia is characterized by decreased skeletal muscle plus low muscle strength and /or physical performance . This study was performed to determine the association of sarcopenia with short-term postoperative outcomes after gastrectomy for gastric cancer . Methods We conducted a prospect i ve study of 255 consecutive patients with gastric cancer who underwent curative gastrectomy .  The sarcopenia elements , including lumbar skeletal muscle index , h and grip strength , and gait speed , were measured before surgery . Patients were followed up after gastrectomy to gain the actual clinical outcomes . Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis . Results Sarcopenia was present in 32 of 255 patients ( 12.5 % ) , and was significantly correlated with advance age , lower body mass index , higher nutritional risk screening ( NRS ) 2002 score , and lower preoperative serum albumin and hemoglobin . Compared with non-sarcopenic patients , sarcopenic patients had a higher risk of postoperative complications , longer postoperative hospital stay , and more hospital costs . In univariate analysis , sarcopenia ( p < 0.001 ) , nutritional risk ( NRS 2002 score ≥3 ; p = 0.003 ) , advanced age ( ≥75 years ; p = 0.014 ) , anemia ( p = 0.012 ) , hypoalbuminemia ( p = 0.029 ) , and diabetes ( p = 0.014 ) were associated with postoperative complications . Multivariable analysis revealed that sarcopenia ( p < 0.001 ) and diabetes ( p = 0.006 ) were independent predictors of postoperative complications . Conclusions Sarcopenia is an independent predictor of postoperative complications in patients with gastric cancer after gastrectomy
target: ConclusionS arcopenia and frailty seem to have significant adverse impacts on the occurrence of postoperative outcomes .
background: Background Gastric cancer is a major health problem , and frailty and sarcopenia will affect the postoperative outcomes in older people .
  However , there is still no systematic review to determine the role of frailty and sarcopenia in predicting postoperative outcomes among older patients with gastric cancer who undergo gastrectomy surgery .