P1.199. Preoperative Frailty Testing for Esophagectomy: Stair-Climb Time as the Strongest Predictor of Major Complications
TL;DR
Of the frailty assessments studied, stair-climb time was the only measure significantly associated with major complications after MIE, underscoring the need for reliable routine preoperative risk stratification tools.
Abstract
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Esophageal cancer is increasingly common in an aging population. Esophagectomy remains a cornerstone of treatment but carries substantial perioperative risk. Accurate preoperative risk assessment is therefore essential. Commonly used tools (e.g. NSQIP frailty index perform poorly in predicting complications after esophagectomy. This study aimed to compare exercise-based and other validated frailty indices to determine the best predictor of major postoperative complications following minimally invasive esophagectomy (MIE) for esophageal cancer. We conducted a prospective cohort study of patients undergoing elective MIE at a tertiary referral center between October 2020 and January 2025. Preoperative frailty assessments included: two-floor stair-climb time, pulse and oxygen-saturation changes during stair climbing, grip strength, and the Edmonton Frail Scale (EFS) score. The primary outcome was a major complication (Clavien–Dindo grade ≥ III) within 30 days. Spearman correlations were calculated among frailty measures. Univariate T-test and multivariate analyses compared frailty metrics between patients with and without major complications. Receiver operating characteristic (ROC) curves assessed the discriminatory ability of each measure and combined models. A total of 105 patients were enrolled (age 64.4 ± 10.5 years; 81% male). Median LOS 9 (IQR 8-13) and ICU 4 (IQR 3-6). The anastomotic leak rate was 8.6% (n = 9), major complication rate 29.5% (n = 31), and 30-day mortality 1% (n = 1). Stair-climb time correlated significantly with grip strength (r = –0.42, p < 0.001) and EFS (r = 0.43, p < 0.001). Patients with major complications had significantly longer stair-climb times (48.2 ± 14.2 s vs 39.7 ± 10.3 s, p= 0.001). EFS scores trended higher in the major complication group but did not reach statistical significance (4.6 ± 2.7 vs 3.7 ± 2.1, p = 0.068). No significant differences were observed in pulse, oxygen saturation changes, or grip strength. (Table 1) In multivariate analysis, longer stair-climb time independently predicted major complications (OR 1.06,95% CI: 1.01-1.12, p = 0.031) with moderate discrimination (AUC of 0.688, 95% CI0.573–0.803) (Figure 1). Esophagectomy remains one of the highest risk surgeries, underscoring the need for reliable routine preoperative risk stratification tools. Of the frailty assessments studied, stair-climb time was the only measure significantly associated with major complications after MIE. As a simple global test of cardiopulmonary, neurologic, and musculoskeletal function, the stair-climb test offers a practical and effective way to enhance preoperative prognostication for patients undergoing MIE.