The impact of frailty on postoperative outcomes of Veterans with stage I non-small cell lung cancer

Abstract: BACKGROUND: Although surgical resection is the standard of care for early-stage non-small cell lung cancer, frailty influences treatment decisions. We evaluated the prognostic utility of the Veterans Affairs Frailty Index, a claims-based assessment tool, among veterans undergoing resection for stage I non-small cell lung cancer. METHODS: We conducted a retrospective cohort study of veterans who underwent curative-intent surgery for stage I non-small cell lung cancer in the Veterans Health Administration from 2006 to 2020. Using the Veterans Affairs Frailty Index, frailty was categorized as follows: nonfrail (≤0.1), prefrail (0.1-0.2), mildly frail (0.2-0.3), moderately frail (0.3-0.4), and severely frail (>0.4). The primary outcome was overall survival, assessed using multivariable Cox regression. Secondary outcomes included major complications, prolonged hospitalization, 30-day readmission, 90-day mortality, and recurrence. RESULTS: Among 12,271 veterans, 7.7% were severely frail. Compared with nonfrail patients, severely frail patients were older (mean age 70.3 years vs 64.7 years; P < .001) and were more likely to undergo minimally invasive surgery (57.7% vs 37.8%) and sublobar resection (41.2% vs 22.3%) (all P < .001). Severe frailty was independently associated with higher risk of major complications (adjusted odds ratio 2.85, 95% confidence interval 2.18-3.71), prolonged hospitalization (adjusted odds ratio 2.67), 30-day readmission (adjusted odds ratio 1.76), 90-day mortality (adjusted odds ratio 2.87), and worse overall survival (adjusted hazard ratio 2.20, 95% confidence interval 1.97-2.46; all P < .001). Recurrence was not significantly associated with frailty (adjusted hazard ratio 0.87; P = .410). CONCLUSION: Frailty, as measured by the Veterans Affairs Frailty Index, independently predicts adverse postoperative and survival outcomes following resection for stage I non-small cell lung cancer. Preoperative frailty assessment may improve risk stratification and guide surgical decision making.