Comparison of Modified Frailty Index, Clinical Frailty Scale, ECOG Score, and ASA PS Score in Predicting Postoperative Outcomes in Cancer Surgery: A Prospective Study

Multiple pre-operative risk assessment scores are available for risk stratification of cancer patients undergoing surgery. This is the first study comparing commonly used preoperative risk assessment tools of Eastern Cooperative Oncology Group Performance Scale (ECOG) and American Society of Anaesthesiologists Physical Status Scale (ASA PS) with frailty scores of Modified Frailty Index (MFI) and Clinical Frailty Scale (CFS). This is a prospective observational study of adult cancer patients undergoing oncosurgery in a tertiary cancer center over one year. Pre-operative risk stratification was done using CFS, MFI, ASA PS, and ECOG scales. All patients were followed up postoperatively for 30 days, and complications were documented. Univariate and multivariate analyses were performed. p value of <= 0.05 was considered significant. Of the 4107 patients studied, 12.6% had prolonged hospitalization, 6.1% had morbidity, 0.9% had readmission, and mortality was 0.6%. ASA PS, ECOG, and CFS were significantly associated with prolonged hospitalization, morbidity, and mortality. MFI was significantly associated with prolonged hospitalization and morbidity. No score could predict readmission. On multivariate analysis, morbidity and readmission were significantly associated with neoadjuvant therapy (p=0.001), mortality with emergency surgery (p=0.001), and prolonged hospitalization with stage III and IV cancer (p=0.001). In adult patients undergoing oncosurgery, ASA PS, ECOG, and CFS are predictors of prolonged hospitalization, morbidity, and mortality. MFI is predictive of prolonged hospitalization and morbidity. None of the studied pre-operative risk scores predict readmission. Newer predictive tools with cancer-specific factors are required for better risk stratification of cancer patients undergoing surgery.