Frailty Predicts Severe Postoperative Complication after Elective Hepatic Resection

Background: Frail patients are likely to suffer from postoperative complication, but this assumption has not been well confirmed. Objectives: This study aims to clarify the importance of frailty in patients undergoing hepatectomy for predicting severe postoperative complications. Method: One hundred and forty-three patients aged >65 years undergoing hepatectomy between 2011 and 2016 were enrolled in this study. The relevance of frailty versus sarcopenia for postoperative outcome was assessed. We defined clinical frailty (CF) as a CF scale >4. Sarcopenia was defined by the total muscle area at the level of the third lumbar vertebra measured on computed tomography. Results: There were 16 patients (11%) with CF and 80 patients (56%) with sarcopenia. CF was associated with high age (p < 0.0001), severe postoperative complications (Clavien-Dindo classification ≥3) (p = 0.0059), and postoperative in-hospital stay (p = 0.0013). On the other hand, sarcopenia was not associated with postoperative outcome. Logistic regression analysis revealed that only CF was an independent predictor of severe postoperative complication (risk ratio of 4.2; p = 0.017). The occurrence of organ/space surgical site infection was significantly higher in the frailty group than in the non-frailty group. Conclusion: CF, but not sarcopenia, is a robust predictor of severe postoperative complications for patients undergoing hepatectomy.