Frailty Index Comparison in Predicting Postoperative Outcomes in Hepatic Cystic Echinococcosis: A Nested Case-Control Study

Background

Postoperative complications (POC) following surgery for hepatic cystic echinococcosis (HCE) remains a persistent clinical challenge. The utility of frailty indices (FIs) as predictors of POC in this context has not been investigated. This study aimed to assess predictive value of three FIs—mFI-11, FRAIL, and PRISMA-7—for POC in patients undergoing surgery for HCE.

Methodology/Principal findings

Nested case–control study. Patients who underwent elective surgery for HCE (2012-2020), matched in a 1:1 case-to-control ratio were included. Cases were defined as patients with mFI-11 score ≥0.27, PRISMA-7 ≥3, or FRAIL ≥3; controls were those with mFI-11 <0.27, PRISMA-7 <3, or FRAIL <3. The primary outcome was POC. Surgical procedures included pericystectomy and hepatic resection. Descriptive statistics and bivariate analyses were applied. Logistic regression, odds ratios (OR) with 95% confidence intervals were calculated. 140 patients were included (70 cases and 70 controls). In multivariable logistic regression, mFI-11 ≥0.27 was identified as an independent prognostic factor for overall and severe POC (p<0.001 and p=0.02, respectively). On the other hand, PRISMA-7 ≥3 was also identified as an independent prognostic factor for overall and major POC (p=0.02 and p=0.03, respectively); and FRAIL scale an independent prognostic factor for overall POC (p=0.005).

Conclusion/Significance

Frail patients exhibited higher frequency and severity of POC compared to non-frail patients. mFI-11 demonstrated the best performance in predicting overall and severe POC.

Author summary

Cystic echinococcosis is a neglected zoonotic tropical disease that primarily affects impoverished pastoral communities worldwide. It involves a parasitic cycle between farm dogs and livestock, often linked to livestock farming practices and the feeding of infected offal to dogs. In humans, the disease causes significant morbidity and mortality through the development of cysts in various organs, most commonly the liver

Three frailty indices were applied to patients who underwent surgery for HCE, to assess their predictive capacity for POC development between frails (cases) and non-frails (controls). An mFI-11 ≥0.27 is an independent predictive factor for POC.

The importance of this finding lies in knowing that likelihood for overall POC in these patients with an mFI-11 ≥0.27 is five times higher.