Associations of age, frailty status, and comorbidity status with post-operative outcomes following CRS-HIPEC.

Abstract

e16060 Background: Cytoreductive surgery, combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), is a promising intervention used to treat disseminated peritoneal cancers. However, not all patients with peritoneal disease are candidates for CRS-HIPEC. This study sought to assess how factors such as age, frailty, and comorbidity status are associated with postoperative outcomes for patients undergoing CRS-HIPEC, including complications, length of hospital stay, discharge disposition, and readmissions. Methods: A retrospective review of demographics, comorbidities, and post-operative data was performed on 216 patients who underwent CRS-HIPEC from 2018 through 2022 at a high-volume CRS-HIPEC academic institution. All patients independent of diagnoses were included, and patients under 18 years of age were excluded. Patients with a Modified Five-Item Frailty Index (mfi-5) score of ≥2 were considered clinically frail and those with Charlson Comorbidity Index (CCI) score of ≥3 were grouped as moderate-to-severe comorbidity status. Categorical associations were tested with Chi-square or Fisher’s exact tests. All tests were two-tailed and conducted in Statistical Analysis System® (SAS) software, Version 9.4. Results: 216 patients met the study’s inclusion criteria. Frailty was significantly associated with severe complications (OR 3.21, p = 0.01), non-routine discharges (OR 2.87, p = 0.046), and 90-day readmissions (OR 3.52, p = 0.003). Patients with higher CCI scores also demonstrated higher risks of severe complications (p = 0.03), non-routine discharges (p = 0.0015), and readmissions (p = 0.006). Elderly patients were more likely to require non-routine discharges (OR 0.23, p = 0.003) and had higher readmission rates (OR 0.33, p = 0.01) but were not at increased risk of severe complications. Conclusions: This study highlights frailty and comorbidity burden (CCI) as key predictors of adverse outcomes following CRS-HIPEC, with frailty strongly associated with severe complications, non-routine discharges, and readmissions. While elderly patients had higher rates of non-routine discharges and readmissions, age alone was a weaker predictor of complications compared to frailty and CCI. These findings suggest that age alone may not be a contraindication for CRS-HIPEC. Preoperative assessments focusing on frailty and comorbidities may better guide patient selection and postoperative care strategies to optimize outcomes.