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Head and Neck Surgery

(316) Modified Frailty Index Associates with TORS Complications and Survival

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Disclosure(s):
Amiti Jain, BS: No relevant relationships to disclose.
Zachary D. Urdang, MD, PhD: No relevant relationships to disclose.
David M. Cognetti, MD: No relevant relationships to disclose.


Introduction: The modified frailty index (mFI-5) is a National Surgical Quality Improvement Program-derived 5-factor index that has been proven to reflect frailty and predict morbidity and mortality. The mFI-5's validity to predict transoral robotic surgery (TORS) outcomes has yet to be reported.

Methods: Retrospective study utilizing the TriNetX multi-centered US-collaborative health records network querying for TORS patients (CPT: 8E09XCZ). Cohorts were stratified by mFI-5 score which uses five ICD-10 codes: non-independent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching (PSM) for age group at index (decade of life 40-89 years). Outcome measures included survival, post-operative infection, pneumonia, tracheostomy dependence, and PEG dependence. All odds-ratios reported were normalized to mFI-5 = 0.

Results: 8,415 patients who underwent TORS were included in final analysis. Greater mFI-5 scores predicted decreased survival and increased incidence of post-operative infection and pneumonia. Odds of 5-year mortality was 1.93 (1.69,2.22; p=0.0003) for mFI-5=2 and 1.90 (1.44,2.52; p=0.0002) for mFI-5=3. Odds of 2-year mortality were 1.25 (1.06,1.47; p=0.0125) for mFI-5=1, 1.58 (1.26,1.97; p= 0.0002) for mFI-5=2, and 1.87 (1.29,2.72; p=0.003) for mFI-5=3. Odds of post-op infection were 1.51 (1.09,2.09; p=0.02) for mFI-5=2 and 1.78 (1.02,3.13; p=0.05) for mFI-5=3. 2-year odds of developing pneumonia were 1.69 (1.33,2.15; p= 0.0001) for mFI-5=2 and 2.84 (1.90,4.24; p< 0.0001) for mFI-5=3. 2-month odds of pneumonia were 1.50 (1.06,2.11; p=0.0259) for mFI-5=2 and 2.55 (1.39,4.68 p=0.0037) for mFI-5=3. mFI-5=4 or 5 had too few patients to analyze. Using polynomial regression to model age versus incident 5-year post-TORS death (R2=0.99), mFI-5 scores better predicted survival than age alone.

Conclusions: This study demonstrates that mFI-5 predicts mortality, pneumonia, and post-operative infection independently of age. This highlights the utility of the mFI-5 for predicting TORS outcomes.