TOPLINE:

A cross-sectional study found that frailty — but not chronological age — was associated with higher risk for local and systemic postoperative complications in older women undergoing surgery for nonmetastatic breast cancer.

METHODOLOGY:

• Frailty is associated with higher postoperative complication rates after major surgery. However, its effect on outcomes after breast cancer surgery, which includes lower-risk procedures, remains unclear.
• Researchers conducted a cross-sectional study using SEER-Medicare data from 6963 women aged 70 years or older who underwent surgery for nonmetastatic breast cancer between September 2013 and September 2015.
• Frailty was defined as a score of more than 0.2 on a validated claims-based index in the year before diagnosis. Overall, 6.3% of patients had frailty; a higher proportion of patients with vs without frailty were aged 85 years or older (19.3% vs 13.4%), had a Charlson Comorbidity Index score of ≥ 2 (64.7% vs 16.5%), or underwent mastectomy (56.0% vs 49.3%; P < .001 for all).
• The researchers identified local complications (surgical-site infection, seroma, hematoma, and wound complications) and systemic complications (sepsis, pneumonia, myocardial infarction, deep vein thrombosis, and pulmonary embolism) that occurred within 30 days post-surgery.

TAKEAWAY:

• Overall, 13.9% of patients had complications — 2.8% systemic and 11.1% local. Complication rates varied by procedure type, ranging from 8.2% for lumpectomy alone to 16.8% for mastectomy with axillary surgery.
• Patients with frailty experienced higher rates of systemic complications (4.8% vs 2.7%; P = .009) and local complications (15.1% vs 10.8%; P = .006) than those without frailty. In adjusted analyses, frailty was associated with a higher likelihood of local (odds ratio [OR], 1.48) and systemic (OR, 1.76) complications.
• Chronological age showed no significant association with complication risk. Frailty, the authors noted, may be associated with physical factors (such as impaired wound healing) or medical factors (comorbidities requiring anticoagulation, for example) that contribute to postoperative complications.

IN PRACTICE:

"Our findings suggest that frailty and not chronological age alone should be considered in surgical decision-making and planning,” the authors wrote. In particular, they added, "patients with frailty traveling long distances, with little social support, or with low health literacy may require more robust postoperative support and navigation from clinicians or at-home services."

SOURCE:

The study, led by Eliza H. Lorentzen, MD, Brigham and Women's Hospital, Boston, Massachusetts, was published online in JAMA Network Open.

LIMITATIONS:

Limitations included reliance on SEER-Medicare coding and the absence of a clinical gold standard for frailty assessment. The study also lacked detail on factors influencing complication risk and on the clinical significance of complications.

DISCLOSURES:

The collection of cancer incidence data used in the study was supported by the California Department of Public Health, the US National Cancer Institute, and US Centers for Disease Control and Prevention. Lorentzen was supported by the Brigham and Women's Department of Surgery Hale Family Research Fellowship. Several authors reported receiving grants, personal fees, and having other ties with various sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.