Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery. (11th May 2021)

• Record Type: Journal Article
• Authors: Goshtasbi, Khodayar; Birkenbeuel, Jack L.; Lehrich, Brandon M.; Abiri, Arash; Haidar, Yarah M.; Tjoa, Tjoson; Kuan, Edward C.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 166:Number 3(2022)
• Page Start: 482
• Page End: 489
• Publication Date: 2021-05-11
• Subjects: frailty -- NSQIP -- morbidity -- mortality -- complications; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/01945998211010443
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objectives: To evaluate the impact of preoperative frailty on short‐term outcomes following complex head and neck surgeries (HNSs). Study Design: Cross‐sectional database analysis. Setting: American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) database. Methods: The 2005 to 2017 ACS‐NSQIP was queried for patients undergoing complex HNS. Five‐item modified frailty index (mFI) was calculated based on functional status and history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and chronic hypertension. Results: A total of 2786 patients (73.1% male) with a mean age of 62.0 ± 11.6 years were included. Compared to nonfrail patients (41.2%), patients with mFI ≥1 (58.8%) had shorter length of operation ( P =. 021), longer length of stay (LOS) ( P <. 001), and higher rates of 30‐day reoperation ( P =. 009), medical complications ( P <. 001), discharge to nonhome facility (DNHF) ( P <. 001), and mortality ( P =. 047). These parameters remained statistically significant when compared across all individual mFI scores (all P <. 05). After adjusting for age, sex, race, body mass index, smoking, and American Society of Anesthesiologists score via multivariate logistic regression, patients with mFI ≥1 were significantly more likely to undergo reoperation (odds ratio [OR], 1.39), surgical complications (OR, 1.19), medical complications (OR, 1.55), prolonged LOS (OR, 1.29), and DNHF (OR, 1.56) (all P <. 05). Multivariate logistic regression also demonstrated that after adjusting for confounders, compared to patients with mFI = 1, patients with mFI = 2‐5 (18.7%) were more likely to undergo shorter operations (OR, 0.74), have medical (OR, 1.46) or any complications (OR, 1.27), and have DNHF (OR, 1.62) (all P <. 05). Conclusion: The 5‐point mFI can independently predict short‐term surgical outcomes following complex HNS. This simple and reliable metric can potentially lead to improved preoperative counseling and postoperative planning for complex HNS patients.