Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

Goshtasbi, Khodayar; Birkenbeuel, Jack; Lehrich, Brandon M.; Abiri, Arash; Haidar, Yarah M.; Tjoa, Tjoson; Kuan, Edward C.

doi:10.1177/01945998211010443

Cited by 25 publications

(41 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The positive association between patients' mFI‐5 scores and increases in hospital LOS has previously been reported after vestibular schwannoma resection, 15 head and neck microvascular reconstruction, 13 thyroidectomy, 11 and complex head and neck surgery. 12 In each of these studies, the mFI‐5 score has been shown to be a better predictor for postoperative complications than patient age.…”

Section: Discussionmentioning

confidence: 99%

“…The mFI‐5 has been shown to be predictive of post‐operative complications. 10 It has been used to study complications in settings including thyroidectomy for multinodular goiter, 11 short‐term surgical outcomes following complex head and neck surgery, 12 perioperative risk in head and neck microvascular reconstruction, 13 and postoperative complications after skull base surgery. 14 The objective of this study was to assess the rate of complications after middle fossa craniotomy for repair of spontaneous CSF leak or encephalocele and evaluate the ability of the mFI‐5 to predict the risk of increased length of stay or added morbidity after surgery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Frailty in middle cranial fossa approach for encephalocele or cerebrospinal fluid leak repair

Hatch

Surdell

Gard

et al. 2022

Laryngoscope Investig Oto

View full text Add to dashboard Cite

Objective: The modified 5-item frailty index (mFI-5) is a concise, comorbidity-based risk stratification tool that can predict adverse outcomes after surgery. The goal of this study was to understand the frailty of patients undergoing surgery for temporal encephalocele or cerebrospinal fluid (CSF) leak and the utility of mFI-5 for predicting increased post-operative outcomes.Methods: A retrospective review of adults with temporal encephalocele or CSF leak who underwent middle cranial fossa (MCF) approach craniotomies with or without mastoidectomy from January 2015 through August 2021 at a tertiary care academic medical center was performed. Patients who underwent additional surgeries or extended surgical approaches were excluded. The mFI-5 was calculated for all patients. Demographic and clinical data were obtained from the medical record.Results: Thirty-six patients underwent 40 MCF approach craniotomies for temporal encephalocele or CSF leak, including three revision cases and one patient with sequential bilateral operations. Mean age was 54.1 ± 10.8 years, and 66.7% were female. In the univariable regression analysis, mFI-5 score, age, and procedure time use were significantly associated with increased hospital length of stay (LOS) but not increased intensive care unit (ICU) LOS. Anesthesia time and lumbar drain were significantly associated with increased hospital LOS and ICU LOS, and they remained significantly associated with increased hospital LOS in the multivariable model. Conclusion:Frailty is associated with increased hospital LOS stay among patients undergoing MCF approach for CSF leak or encephalocele. Reducing anesthesia time and avoiding lumbar drain use are potentially modifiable risk factors that can reduce the LOS and associated costs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frailty in middle cranial fossa approach for encephalocele or cerebrospinal fluid leak repair

Hatch

Surdell

Gard

et al. 2022

Laryngoscope Investig Oto

View full text Add to dashboard Cite

show abstract

“…It consists of four comorbid conditions (pulmonary disease, congestive heart failure, diabetes mellitus and hypertension) and one functional status (16-18). Similar to the original 11-mFI, the 5-mFI has been proven to be an acceptable predictor of outcome in various surgeries, including paraesophageal hernia repair, multiorgan resections, trauma, nephrectomy, breast reconstruction, spine surgery, and complex head and neck surgery (15,16,(18)(19)(20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 89%

The five-item modified frailty index predicts long-term outcomes in elderly patients undergoing colorectal cancer surgery

Ogata

Sadakari

Nakane

et al. 2023

Preprint

View full text Add to dashboard Cite

Background. Frailty has been globally recognized as a predictor of adverse postoperative outcomes. A frailty assessment using the five-factor modified frailty index (5-mFI) has recently gained traction; however, long-term outcomes are unknown in colorectal cancer (CRC) surgery. This study aimed to investigate whether the 5-mFI predicted long-term survival and cause of death based on severity of frailty in elderly patients with CRC surgery, as well as to determine risk factors for mortality. Methods. A total of 299 patients underwent CRC surgery with curative intent between January 2013 and December 2017. Patients were divided into three groups based on 5-mFI score: group 1 (5-mFI: 0, 1; n=164) with no frailty, group 2 (5-mFI: 2; n=91) with moderate frailty, and group 3 (5-mFI≥3; n=44) with severe frailty. Clinicopathological variables, including comorbidity, 5-mFI, prognostic nutrition index, operative/postoperative data, and outcome, including cause of death, were compared among the three groups. To identify factors associated with death from CRC and non-CRC-related causes, univariate and multivariate analyses using the Cox regression model were performed. Results. The immediate postoperative morbidity of patients with Clavien-Dindo grades of III or greater (9.1%) in group 3 was not significantly different from that in group 1 (9.1%) or group 2 (14.3%); however, the 30-day mortality rate (4.5%) in group 3 was significantly higher. Long-term disease-free survival was similar among frailty groups, suggesting that CRC surgery provides oncological benefit to patients irrespective of frailty. The 5-year survival rates in groups 1, 2, and 3 were 83.5%, 71.2%, and 47.9%, respectively, showing a significantly lower survival rate as frailty advanced. Sixty percent of deaths in frail patients were primarily from respiratory failure and cardiovascular diseases. Multivariate analysis demonstrated that advanced age, higher 5-mFI, and longer postoperative hospital stay were risk factors for mortality unrelated to CRC. Multivariate analysis also revealed that advanced tumor stage, CEA>5 ng/ml, undifferentiated tumor and R1 resection were risk factors for CRC death. Conclusion. The 5-mFI can be a predictor of postoperative short- and long-term outcomes and risk factors for mortality unrelated to CRC. In addition, long-term survival was shown to be negatively associated with the 5-mFI score.

show abstract

“…The RAI is a validated widely used model to predict frailty and short‐term adverse events in oncology patients (Hall et al, 2017). The mFI 5 is a validated risk index to predict postoperative adverse events in head and neck patients (Goshtasbi et al, 2021; Subramaniam et al, 2018; Wachal et al, 2017). Tumor‐related factors, including AJCC eighth Edition TNM stage, subsite, histopathology and need for adjuvant treatment were also documented.…”

Section: Methodsmentioning

confidence: 99%

Cervical paraspinal skeletal muscle index outperforms frailty indices to predict postoperative adverse events in operable head and neck cancer with microvascular reconstruction

et al. 2021

View full text Add to dashboard Cite

Objective: Sarcopenia is increasingly being recognized as a negative prognostic factor in patients with head and neck cancer (HNC). We associate a sarcopenia biomarker measured radiographically from computed tomography (CT) of the neck to postoperative adverse events in patients with operable HNC.Patients and methods: A prospective cohort of treatment-naïve HNC patients undergoing surgery with microvascular reconstruction was performed. Cervical paraspinal skeletal muscle index (CPSMI) was calculated using preoperative CT neck imaging and adjusted for height and sex. Postoperative adverse events, including Clavien-Dindo Grade 3+ complications and fistula, were recorded within 30-days of the index surgery. Multivariate logistic regression was used to evaluate the association between CPSMI and postoperative complications. The modified frailty index (mFI) and Risk Assessment Index (RAI) were compared with CPSMI outcomes.Results: A total of 127 patients with mucosal HNC were included in the study. The mean age was 60.5 years, and 87 (68.5%) patients were male. Sixty Clavien-Dindo grade 3+ events occurred; 17 patients developed an oro/pharyngocutaneous fistula.Low CPSMI was independently associated with Clavien-Dindo Grade 3+ events (OR 2.80, 95% CI of 1.18-6.99) and fistula (OR of 6.10, 95% CI of 1.53-24.3) when adjusted for multiple factors. CPSMI outperformed the mFI and RAI frailty indices to predict postoperative adverse events (p < .05). Conclusion:Low CPSMI is independently associated with postoperative adverse events and outperforms current frailty indices inoperable HNC with microvascular reconstruction.

show abstract

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

Cited by 25 publications

References 49 publications

Frailty in middle cranial fossa approach for encephalocele or cerebrospinal fluid leak repair

Frailty in middle cranial fossa approach for encephalocele or cerebrospinal fluid leak repair

The five-item modified frailty index predicts long-term outcomes in elderly patients undergoing colorectal cancer surgery

Cervical paraspinal skeletal muscle index outperforms frailty indices to predict postoperative adverse events in operable head and neck cancer with microvascular reconstruction

Contact Info

Product

Resources

About