The Role of Frailty and ASA Classification in Perioperative Outcomes Stratification for Esophagectomy Patients: A Retrospective Study

Background: Esophagectomy is a high-risk procedure associated with significant morbidity and mortality. Accurate preoperative risk assessment tools are essential for identifying patients who are most vulnerable to complications. The primary objective of this study was to evaluate the predictive accuracy of the modified frailty index (mFI-5) and the American Society of Anesthesiologists Physical Status (ASA-PS) classification in identifying patients at high risk of postoperative morbidity and mortality following esophagectomy. Methods: This retrospective study analyzed 127 patients who underwent esophagectomy at Songklanagarind Hospital. Patient demographics, perioperative variables, and outcomes were collected. Predictors of 30-day morbidity were identified using logistic regression, and the performance of mFI-5 and ASA-PS scores was assessed using Receiver Operating Characteristic (ROC) curves. Results: Severe postoperative complications were 48%. Significant predictors included ASA ≥ 3, preoperative chemoradiotherapy (CRT), and prolonged ICU and hospital stays. The ASA-PS classification offered better overall accuracy in predicting morbidity. While the mFI-5 showed high sensitivity, it exhibited poor specificity, resulting in a high false-positive rate. Conclusions: Both mFI-5 and ASA-PS have limitations in predicting morbidity and mortality after esophagectomy. However, a model that integrates various perioperative factors, particularly preoperative and postoperative variables, demonstrated significance.