974P - The barthel index predicts surgical textbook outcomes following hepatectomy for elderly patients with hepatocellular carcinoma: A multicenter cohort study from China

Background

The burgeoning demand for hepatectomy in elderly patients with hepatocellular carcinoma (HCC) necessitates improved perioperative care. Geriatric populations frequently experience functional decline and frailty, predisposing them to adverse postoperative outcomes. The Barthel Index serves as a reliable measure for assessing functional capacity, and this study evaluates its impact on surgical textbook outcomes (TOs) as composite quality indicators following hepatectomy in elderly HCC patients.

Methods

A multicenter retrospective cohort study analyzed elderly patients (≥70 years) who underwent hepatectomy for HCC between 2013 and 2021 at 11 Chinese hospitals. Utilizing a Barthel Index cut-off value of 85, patients were divided into two groups: with and without preoperative functional decline and frailty. The primary outcome was TO, encompassing seven criteria. TO rates were compared between groups, and multivariate logistic regression analyses identified independent risk factors for achieving TOs.

Results

Of 497 elderly HCC patients, 157 (31.6%) exhibited preoperative functional decline and frailty (Barthel Index score <85). The overall TO rate was 58.6%. Patients with preoperative Barthel Index score <85 had significantly lower TO rates compared to patients with preoperative Barthel Index score ≥85 (29.3% vs. 72.1%, P<0.001). Similar differences emerged regarding perioperative blood transfusion, postoperative major morbidity, prolonged hospital stays, 30-day readmission, and 90-day mortality rates. Multivariate analysis revealed preoperative Barthel Index score <85 as an independent risk for achieving TO (odds ratio 3.413, 95% confidence interval 1.879-6.198, P<0.001). Comparable results were observed in subgroup population of patients undergoing open and laparoscopic hepatectomy, respectively.

Conclusions

Preoperative Barthel Index-based assessment of functional decline and frailty significantly predicts TOs following hepatectomy in elderly HCC patients, enabling identification of high-risk patients and informing preoperative management and postoperative care within geriatric oncology.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Tian Yang.

Funding

National Natural Science Foundation of China; Dawn Project Foundation of Shanghai; Shanghai Health Academic Leader Program.

Disclosure

All authors have declared no conflicts of interest.