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Head and Neck Surgery

Associations Between Frailty and Outcomes in Patients Undergoing Reconstruction

Sunday, October 1, 2023
3:57 PM - 4:03 PM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Sruti Tekumalla, BA

    Medical Student
    Sidney Kimmel Medical College
    Philadelphia, Pennsylvania, United States

    • Co-Author(s)

  • KG

    Kate Gillmore

    Medical Student
    Thomas Jefferson University - Sidney Kimmel Medical College
    Philadelphia, PA, United States

    • Author(s)

  • Amiti Jain

    Medical Student
    Thomas Jefferson University - Sidney Kimmel Medical College
    Philadelphia, PA, United States

  • Arielle G. Thal, MD

    Assistant Professor
    Thomas Jefferson University
    Philadelphia, PA, United States

  • ZU

    Zachary D. Urdang, MD, PhD

    Resident
    Monument Health
    Flagstaff, AZ, United States

    • Senior Author(s)

  • David M. Cognetti, MD

    Professor and Chair, Department of Otolaryngology
    Thomas Jefferson University
    Philadelphia, PA, United States

  • Joseph M. Curry, MD

    Professor
    Thomas Jefferson University Hospital
    Wynnewood, PA, United States

Disclosure(s):
Amiti Jain: No relevant relationships to disclose.
Arielle G. Thal, MD: No relevant relationships to disclose.
Zachary D. Urdang, MD, PhD: No relevant relationships to disclose.
Introduction: The five-point modified frailty index (mFI-5) stratifies patients based on the presence of the following conditions: diabetes mellitus, congestive heart failure within 30 days of surgery, hypertension on medication, COPD or pneumonia history, and functional status. We hypothesize that mFI-5 score, independent of age, predicts mortality and complication risk in head and neck cancer (HNC) patients undergoing free flap reconstruction.

Methods: This is a retrospective real-world database study using the live TriNetX Research Network representing ~110-million patients from 56 health care organizations. Electronic medical record data was queried for HNC patients who underwent free flap reconstruction. 11,146 patients were stratified by mFI-5 score and decade of life (20-89 years). Propensity score matching was used to match patients for age at index. Odds of death and post-surgical complications were measured at 2 months and 5 years.

Results: Odds ratios are normalized to the mFI-5=0 cohort. Odds for 2 month mortality were 2.489 (1.866;3.321, p< 0.0001) for mFI-5=1, 3.284 (2.434;4.429, p= < 0.0001) for mFI-5=2 and 3.567 (2.267;5.611, p< 0.0001) for mFI-5=3. Odds for 5 year mortality were 1.478 (1.359;1.607, p< 0.0001) for mFI-5=1, 1.752 (1.607;1.911, p< 0.0001) for mFI-5=2, 1.924 (1.675;2.209, p< 0.0001) for mFI-5=3, 3.232 (2.294;4.555, p= < 0.0001) for mFI-5=4 and 3.257 (1.905;5.568, p< 0.0001) for mFI-5=5. Odds of tracheostomy at 2 months were 1.31 (1.048;1.639, p=0.0175) for mFI-5=1, 1.902 (1.512;2.393, p< 0.0001) for mFI-5=2 and 2.313 (1.613;3.318, p< 0.0001) for mFI-5=3. Odds of PEG tube at 2 months were 1.429 (1.219;1.676, p< 0.0001) for mFI-5=1, 2.139 (1.823;2.509, p< 0.0001) for mFI-5=2, 2.362 (1.913;2.917, p< 0.0001) for mFI-5=3, 2.796 (1.832;4.268, p< 0.0001) for mFI-5=4 and 2.258 (1.147;4.446, p=0.0155) for mFI-5=5. Other outcomes were insignificant or had insufficient data.

Conclusions: This study demonstrates that mFI-5 score predicts risk of mortality, tracheostomy and PEG tube independent of age, and therefore has utility in assessing risk in patients undergoing free flap reconstruction.