Modified Frailty Index is Useful in Predicting Non-home Discharge in Elderly Patients with Gastric Cancer Who Undergo Gastrectomy.

Abstract

Development of laparoscopic gastrectomy and the Enhanced Recovery After Surgery (ERAS) protocol enable early discharge to home of patients with gastric cancer (GC). However, a significant proportion of patients are still discharged to inpatient facilities after surgery. We aimed to identify predictive factors of non-home discharge in patients with GC who undergo gastrectomy. We enrolled 517 patients with histopathologically confirmed diagnosis of GC who underwent gastrectomy. The number of patients with non-home discharge was 23 (4.4%), and non-home discharge was only observed in patients with GC aged ≥65 years. Patients were divided into the mFI^High (≥0.272) and mFI^Low (<0.272) groups according to the cut-off value determined by ROC analysis. The mFI^High classification was significantly more frequent in patients aged ≥75 years, who underwent either total or proximal partial gastrectomy, who underwent limited lymph node dissection, and with non-home discharge than in patients aged <75 years (p = 0.0002), those who underwent distal partial gastrectomy (p = 0.032), those who underwent standard lymph node dissection (p = 0.036), and those without non-home discharge (p = 0.0071). Multivariate analysis revealed mFI as an independent predictive indicator of non-home discharge, along with postoperative complications and surgical approach, in patients with GC aged ≥65 years. The frequency of patients with non-home discharge was significantly associated with the number of these three predictive factors in GC patients aged ≥65 years (p < 0.0001). The combination of mFI, postoperative complications, and surgical approach is useful for predicting non-home discharge in patients aged ≥65 years who underwent gastrectomy for GC.