Frailty and risk of complications in head and neck oncologic surgery. Systematic review and dose-response meta-analysis

Abstract

Background There is emerging evidence that frail individuals present a decreased physiological reserve, decreased ability to maintain homeostasis, and increased vulnerability to stressors. The concept of frailty has become increasingly recognized as a valuable measure in oncological surgical patients, including those with head and neck cancer. Preoperative screening for frailty may provide an individualized risk assessment that can be used by an interdisciplinary team for preoperative counseling and to improve outcomes. The aim of this meta-analysis was to evaluate the relationship between frailty and the risk of major postoperative complications in frail individuals submitted to head and neck oncologic surgery. Material and Methods PubMed, SCOPUS, Web of Science, Google Scholar and OpenThesis were systematically searched to identify studies that evaluated the risk of major postoperative complications in frail individuals undergoing head and neck oncologic surgery. The search was performed on August 31, 2020, without language or date restrictions. Two independent investigators screened the searched studies based on each paper’s title and abstract. Relevant studies were read in full and selected according to the eligibility criteria. Frailty was assessed by modified Frailty Index (mFI-11) and major postoperative complications were measured by the Clavien-Dindo classification. We performed a categorical and dose-response meta-analysis using a random-effects model to evaluate the association between frailty and the risk of major postoperative complications in patients submitted to head and neck oncologic surgery. The results of the meta-analysis were expressed as relative risk (RR) and 95% confidence interval (95% CI). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Results Four studies (9,947 patients) were included in this systematic review and meta-analysis. Frail patients presented an increased risk of life-threatening complications requiring intensive care unit (ICU) admission (RR = 4.67; 95% CI 1.54–14.10) and 30-day mortality (RR = 8.10; 95% CI 2.30–28.57) compared to non-frail patients. We found evidence of dose-response trend between mFI-11 and major postoperative complications. Conclusions Higher frailty scores are associated with a significant increase in ICU-level complications and 30-day mortality after head and neck oncologic surgery. Key words: Frailty, head and neck neoplasms, postoperative complications, mortality.

“Age is just a number”; frailty as a marker of peri‐operative risk in head and neck surgery: Systematic review and meta‐analysis

“…The present systematic review and meta‐analysis of 182 059 patients suggests the negative impact of frailty on peri‐operative and oncological outcomes following head and neck oncologic surgery. Our findings mirror those of a meta‐analysis by Mendes et al (consisting of four studies and over 170 000 fewer patients) which demonstrated an association of frailty assessed using the mFI and complications following head and neck surgery 53 . Morbidity following head and neck oncologic surgery is not uncommon with the incidence of postoperative complications estimated at approximately 5.7%–5.9% 3,4 .…”

“…Our findings mirror those of a meta-analysis by Mendes et al (consisting of four studies and over 170 000 fewer patients) which demonstrated an association of frailty assessed using the mFI and complications following head and neck surgery. 53 Morbidity following head and neck oncologic surgery is not uncommon with the incidence of postoperative complications estimated at approximately 5.7%-5.9%. 3,4 Among the nine studies evaluating 30-day postoperative morbidity, the overall incidence of 30-day morbidity following head and neck oncologic surgery in our study was slightly higher (11.1%) and frail patients were almost 3 times more likely to suffer a 30-day morbidity following head and neck oncologic surgery (OR 2.74; 95% CI 1.98-3.80; p < 0.01).…”

Measurement of Sarcopenia in Head and Neck Cancer Patients and Its Association With Frailty

“…Frailty is often defined as an age-related cumulative decline across multiple physiologic systems, with impaired homeostatic reserve and a reduced capacity of the organism to withstand stress, leading to increased risk of adverse health outcomes. In HNC frailty is associated with severe chemoradiation-related complications ( 92 ), postoperative complications ( 93 , 94 ), life-threatening postoperative complications requiring intensive care unit (ICU) admission ( 95 ), length of hospital stay and unplanned readmission ( 96 ), discharge to short-term or skilled nursing facilities ( 94 ), 30-day mortality after head and neck oncologic surgery ( 95 ), poor survival after chemoradiation ( 92 ) and decline in health-related quality of life after treatment ( 97 ). A comprehensive geriatric assessment (CGA) which evaluates physical, psychological, functional, and social capabilities and limitations of geriatric patients is the gold standard to diagnose frailty.…”

Frailty Assessment for Outcome Prediction of Patients With Prostate Cancer Receiving Radical Prostatectomy: A Meta-Analysis of Cohort Studies

“…Clinically, evaluation of frailty is mainly achieved via the comprehensive geriatric evaluation tools, which have become an important part for the nursing and medical care of elderly populations (Lee et al, 2020; Pilotto et al, 2020). More importantly, it has been confirmed that compared to chronological age, frailty may be a better predictor for adverse postoperative complications in patients receiving surgeries for head and neck cancers (Mendes et al, 2021), digestive system tumors (Ding et al, 2021), and bladder cancer (Ornaghi et al, 2020). In patients with PCa, frailty has been suggested to predict the incidence of postoperative complications following radical prostatectomy (Lascano et al, 2015; Levy et al, 2017; Momota et al, 2020; Rosiello et al, 2020; Shahait et al, 2021), however, systematic evaluations with meta-analyses have not yet been performed.…”