The Barthel Index predicts surgical textbook outcomes following hepatectomy for elderly patients with hepatocellular carcinoma: A multicenter cohort study

巴氏指数 医学 肝细胞癌 肝切除术 队列 队列研究 内科学 肿瘤科 外科 普通外科 物理疗法 日常生活活动 切除术
作者
Tian Yang,Daqun Liu,Wei Qiu,Zhongqi Fan,Li‐Yang Sun,Nan-Ya Wang,Hong Wang,Yifan Yang,Jie Li,Ya-Hao Zhou,Ting‐Hao Chen,Xianming Wang,Wei‐Min Gu,Ying-Jian Liang,Li‐Hui Gu,Jia-Hao Xu,Ming‐Da Wang,Xiaodong Sun,Guoyue Lv
出处
期刊:American Journal of Surgery [Elsevier BV]
卷期号:237: 115761-115761 被引量:2
标识
DOI:10.1016/j.amjsurg.2024.05.002
摘要

Background The burgeoning demand for hepatectomy in elderly patients with hepatocellular carcinoma (HCC) necessitates improved perioperative care. Geriatric populations frequently experience functional decline and frailty, predisposing them to adverse postoperative outcomes. The Barthel Index serves as a reliable measure for assessing functional capacity, and this study evaluates its impact on surgical textbook outcomes (TOs) in elderly HCC patients. Methods A multicenter retrospective cohort study analyzed elderly patients (≥70 years) following hepatectomy for HCC between 2013 and 2021. Utilizing a Barthel Index cut-off value of 85, patients were divided into two groups: with and without preoperative functional decline and frailty. The primary outcome was the rate of TO, encompassing seven criteria. TO rates were compared between groups, and multivariate logistic regression analyses identified independent risks for achieving TOs. Results Of 497 elderly patients, 157 (31.6%) exhibited preoperative functional decline and frailty (Barthel Index score <85). The overall TO rate was 58.6%. Patients with preoperative Barthel Index score <85 had significantly lower TO rates compared to patients with score ≥85 (29.3% vs. 72.1%, P<0.001). Multivariate analysis revealed preoperative Barthel Index score <85 as an independent risk for achieving TO (odds ratio 3.413, 95% confidence interval 1.879-6.198, P<0.001). Comparable results were observed in the subgroups of patients undergoing open and laparoscopic hepatectomy. Conclusion Preoperative Barthel Index-based assessment of functional decline and frailty significantly predicts TOs following hepatectomy in elderly HCC patients, enabling identification of high-risk patients and informing preoperative management and postoperative care within geriatric oncology.
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