Frailty Predicts Severe Postoperative Complication after Elective Hepatic Resection

<b><i>Background:</i></b> Frail patients are likely to suffer from postoperative complication, but this assumption has not been well confirmed. <b><i>Objectives:</i></b> This study aims to clarify the importance of frailty in patients undergoing hepatectomy for predicting severe postoperative complications. <b><i>Method:</i></b> One hundred and forty-three patients aged >65 years undergoing hepatectomy between 2011 and 2016 were enrolled in this study. The relevance of frailty versus sarcopenia for postoperative outcome was assessed. We defined clinical frailty (CF) as a CF scale >4. Sarcopenia was defined by the total muscle area at the level of the third lumbar vertebra measured on computed tomography. <b><i>Results:</i></b> There were 16 patients (11%) with CF and 80 patients (56%) with sarcopenia. CF was associated with high age (<i>p</i> < 0.0001), severe postoperative complications (Clavien-Dindo classification ≥3) (<i>p</i> = 0.0059), and postoperative in-hospital stay (<i>p</i> = 0.0013). On the other hand, sarcopenia was not associated with postoperative outcome. Logistic regression analysis revealed that only CF was an independent predictor of severe postoperative complication (risk ratio of 4.2; <i>p</i> = 0.017). The occurrence of organ/space surgical site infection was significantly higher in the frailty group than in the non-frailty group. <b><i>Conclusion:</i></b> CF, but not sarcopenia, is a robust predictor of severe postoperative complications for patients undergoing hepatectomy.