{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:18:56Z","timestamp":1787840336654,"version":"build-2784847793"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Frailty increases vulnerability to stressors, negatively impacting cancer outcomes. We evaluated the association between pre-operative frailty and post-operative outcomes in Indian patients undergoing major abdominal cancer surgery and explored ultrasound-based sarcopenia markers for frailty screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Frailty was assessed using the Fried Frailty Phenotype. The primary outcome was hospital length of stay (LOS); secondary outcomes included severe complications (Clavien\u2013Dindo III\/IV), intensive care unit stay, and 30- and 90-day mortality. Pre-operative ultrasound-guided quadriceps thickness and rectus femoris cross-sectional area (CSA) were measured, and their cut-off values were derived via receiver operating characteristic (ROC) curves as screening parameters for pre-operative frailty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 142 patients, 68 (47.8%) were frail. Frail patients had longer hospital stays {median 9 vs. 6 days; relative risk (RR) 1.20 [95% confidence interval (CI) 1.02 to 1.41]};\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.031. On multivariate analysis, frailty {RR 1.16 [95% CI 1.03 to 1.31]};\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.012 and American Society of Anesthesiologists physical status (ASA-PS) &gt; III {RR 1.35 [95% CI 1.10 to 1.65]};\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.004 independently predicted prolonged LOS. ROC analysis showed poor predictive ability of ultrasonography: {area under curve 0.591 [95% CI 0.497 to 0.685]};\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.061 for body mass index-normalised quadriceps thickness; {0.613 [95% CI 0.519 to 0.707]};\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.020 for rectus femoris CSA, which improved to {0.721 [95% CI 0.636 to 0.806]} with pre-operative anaemia. The diagnostic accuracy was 65.5% and 64.3%, respectively; the sensitivity\/specificity for quadriceps was 78%\/54%, and for rectus femoris, CSA was 50%\/78%. DeLong\u2019s test showed no significant difference (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.6).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Frailty prolongs hospital stay but not complications or mortality. Ultrasound alone poorly predicts frailty. Combining pre-operative anaemia improves the predictive value of rectus femoris ultrasound assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_1337_25","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T11:00:29Z","timestamp":1773399629000},"page":"399-407","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Impact of pre-operative frailty on hospital length of stay in major abdominal oncological surgeries: A prospective, observational study"],"prefix":"10.4103","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1186-3357","authenticated-orcid":false,"given":"Juhi","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9165-3944","authenticated-orcid":false,"given":"Saurabh","family":"Vig","sequence":"additional","affiliation":[{"name":"Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2249-7754","authenticated-orcid":false,"given":"Rajeev","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Ex Scientist (Statistics), Delhi Cancer Registry, All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2785-5530","authenticated-orcid":false,"given":"Sanjay","family":"Thulkar","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Onco-Radiology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9233-809X","authenticated-orcid":false,"given":"Seema","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2097-7180","authenticated-orcid":false,"given":"Sushma","family":"Bhatnagar","sequence":"additional","affiliation":[{"name":"Onco-Anaesthesia, Critical Care, Pain Management, and Palliative Care, Max Saket, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"R1-20260416","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.ygyno.2020.05.046","article-title":"Frailty is a determinant of suboptimal chemotherapy in women with advanced ovarian cancer","volume":"158","author":"Narasimhulu","year":"2020","journal-title":"Gynecol Oncol"},{"key":"R2-20260416","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.cger.2010.02.002","article-title":"The assessment of frailty in older adults","volume":"26","author":"Abellan van Kan","year":"2010","journal-title":"Clin Geriatr Med"},{"key":"R3-20260416","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1001\/jamasurg.2015.5085","article-title":"Association of frailty and 1-year postoperative mortality following major elective noncardiac surgery: A population-based cohort study","volume":"15","author":"McIsaac","year":"2016","journal-title":"JAMA Surg"},{"key":"R4-20260416","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1007\/s00423-022-02515-7","article-title":"Early return to intended oncologic therapy after implementation of an enhanced recovery after surgery pathway for gastric cancer surgery","volume":"407","author":"Garcia-Nebreda","year":"2022","journal-title":"Langenbecks Arch Surg"},{"key":"R5-20260416","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.1200\/JCO.2018.78.8687","article-title":"Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology","volume":"36","author":"Mohile","year":"2018","journal-title":"J Clin Oncol"},{"key":"R6-20260416","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/ALN.0000000000004064","article-title":"Preoperative point-of-care ultrasound to identify frailty and predict postoperative outcomes: A Diagnostic accuracy study","volume":"136","author":"Canales","year":"2022","journal-title":"Anesthesiology"},{"key":"R7-20260416","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: Evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"R8-20260416","doi-asserted-by":"crossref","first-page":"S3846","DOI":"10.21037\/jtd.2018.10.96","article-title":"Psoas muscle area: A new standard for frailty assessment in cardiac surgery?","volume":"10","author":"Balsam","year":"2018","journal-title":"J Thorac Dis"},{"key":"R9-20260416","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.jss.2020.06.043","article-title":"Thigh ultrasound used to identify frail elderly patients with sarcopenia undergoing surgery: A pilot study","volume":"256","author":"Salim","year":"2020","journal-title":"J Surg Res"},{"key":"R10-20260416","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A New proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"R11-20260416","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1056\/NEJMoa1801601","article-title":"Restrictive versus liberal fluid therapy for major abdominal surgery","volume":"378","author":"Myles","year":"2018","journal-title":"N Engl J Med"},{"key":"R12-20260416","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1097\/SLA.0000000000001546","article-title":"Can sarcopenia quantified by ultrasound of the rectus femoris muscle predict adverse outcome of surgical intensive care unit patients as well as frailty? A prospective, observational cohort study","volume":"264","author":"Mueller","year":"2016","journal-title":"Ann Surg"},{"key":"R13-20260416","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1123\/jpah.2021-0314","article-title":"The relationship between preoperative physical activity with American Society of Anesthesiologists score and postoperative length of stay in patients undergoing radical prostatectomy","volume":"19","author":"Papadopoulos","year":"2022","journal-title":"J Phys Act Health"},{"key":"R14-20260416","doi-asserted-by":"crossref","first-page":"e13746","DOI":"10.1111\/ctr.13746","article-title":"Standardized measures of frailty predict hospital length of stay following orthotopic liver transplantation for hepatocellular carcinoma","volume":"33","author":"DeMaria","year":"2019","journal-title":"Clin Transplant"},{"key":"R15-20260416","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1093\/annonc\/mdu540","article-title":"The prevalence and outcomes of frailty in older cancer patients: A systematic review","volume":"26","author":"Handforth","year":"2015","journal-title":"Ann Oncol"},{"key":"R16-20260416","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1111\/ans.16319","article-title":"Pre-operative frailty is predictive of adverse post-operative outcomes in colorectal cancer patients","volume":"91","author":"Richards","year":"2021","journal-title":"ANZ J Surg"},{"key":"R17-20260416","doi-asserted-by":"crossref","first-page":"600","DOI":"10.4103\/ija.ija_872_24","article-title":"Association between preoperative frailty and postoperative delirium and cognitive dysfunction in elderly patients undergoing surgery under general anaesthesia: A prospective observational study","volume":"69","author":"Anjaleekrishna","year":"2025","journal-title":"Indian J Anaesth"},{"key":"R18-20260416","doi-asserted-by":"crossref","first-page":"505","DOI":"10.2147\/CIA.S365494","article-title":"Frailty and cancer: Current perspectives on assessment and monitoring","volume":"18","author":"Goede","year":"2023","journal-title":"Clin Interv Aging"},{"key":"R19-20260416","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/2090598X.2020.1841538","article-title":"Frailty impact on postoperative complications and early mortality rates in patients undergoing radical cystectomy for bladder cancer: A systematic review","volume":"19","author":"Ornaghi","year":"2021","journal-title":"Arab J Urol"},{"key":"R20-20260416","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1001\/archinternmed.2007.113","article-title":"Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women","volume":"168","author":"Ensrud","year":"2008","journal-title":"Arch Intern Med"},{"key":"R21-20260416","doi-asserted-by":"crossref","first-page":"700","DOI":"10.4103\/ija.ija_1338_24","article-title":"Evaluation of the correlation between pre-anaesthetic P-POSSUM score, ultrasound muscle assessment and frailty index on perioperative outcome\u2013An observational trial","volume":"69","author":"Bhalerao","year":"2025","journal-title":"Indian J Anaesth"},{"key":"R22-20260416","doi-asserted-by":"crossref","first-page":"620","DOI":"10.4103\/ija.ija_176_23","article-title":"Processing speed test and 30-day readmission in elderly non-cardiac surgery patients- A retrospective study","volume":"67","author":"Maheshwari","year":"2023","journal-title":"Indian J Anaesth"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_1337_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:20:39Z","timestamp":1787836839000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_1337_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_1337_25","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-10-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-23","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}