Frailty as a Predictor of Postoperative Outcomes among Patients with Head and Neck Cancer

Pitts, Kristen D.; Arteaga, Alberto A.; Stevens, Benjamin P.; White, William J.; Su, Dan; Spankovich, Christopher; Jefferson, Gina D.; Jackson, Lana

doi:10.1177/0194599818825466

Cited by 39 publications

(75 citation statements)

References 12 publications

(58 reference statements)

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“…Our PubMed search yielded nine studies evaluating the association between a frailty measure and perioperative outcome(s) in patients undergoing HNC surgery. Seven studies (77%) used a population‐based database such as NSQIP, NIS (Nationwide Inpatient Sample), or Nationwide Readmissions Database.…”

Section: Resultsmentioning

confidence: 99%

“…In total, three frailty measures were analyzed: 1) the mFI (5 studies, 56%), 2) Johns Hopkins Adjusted Clinical Groups (ACG) frailty‐defining diagnosis indicator (4 studies, 44%), and 3) Groningen Frailty Indicator (GFI) (1 study, 11%). One study examined both mFI and Johns Hopkins ACG. Table highlights the characteristics of included studies, and Table summarizes the outcomes reported in these studies.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies examined frailty using the mFI in head and neck surgery patients in the NSQIP outcome database. Adams et al assessed the ability of the mFI to predict mortality and complications in 6,727 inpatients between the ages of 16 to 90 years (mean 54.7 years) undergoing non‐major HNS (i.e., thyroidectomy, parotidectomy, neck dissection, tonsillectomy, and palatopharyngoplasty).…”

Section: Resultsmentioning

confidence: 99%

“…More recently, Pitts et al examined the predictive power of both the mFI and Johns Hopkins ACG frailty‐defining diagnosis indicator in a retrospective review of 410 HNC patients from 2014 to 2017. This study found that mFI was associated with increased odds of mortality (OR 1.48 [1.09–2.00]), Clavien‐Dindo IV complications (incidence rate ratio [IRR] 1.72 [1.37–2.16]), overall complications (IRR 1.43 [1.22–1.68]), LOS (1.14 [1.05–1.23]), and 30‐day readmission (OR 1.47 [1.13–1.91]).…”

Section: Resultsmentioning

confidence: 99%

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Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Fu¹,

Sklar²,

Cohen³

et al. 2019

The Laryngoscope

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Objective: Frailty has emerged as an important determinant of many health outcomes across various surgical specialties. We examined the published literature reporting on frailty as a predictor of perioperative outcomes in head and neck cancer (HNC) surgery.Study Design: Narrative review with limited electronic database search and cross-referencing of included studies. Methods: PubMed was searched from inception until June 2019 to capture studies evaluating an association between frailty and perioperative outcomes among patients undergoing HNC surgery. Primary outcomes included mortality and morbidity, whereas secondary outcomes included in-hospital cost, length of stay, readmission, and discharge disposition.Results: We identified nine series examining frailty as a predictor of outcomes in HNC. The majority of studies (77%) identified patients using a large population-based database such as the National Surgical Quality Improvement Project or National Inpatient Sample. Frailty measures applied in the HNC surgery literature include the modified frailty index, Groningen Frailty Indicator, and John Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Most studies demonstrated a significant association between frailty and perioperative outcomes, including mortality, perioperative complications, and Clavien-Dindo grade IV complications. Furthermore, frailty was associated with greater length of hospital stay, readmission rate, and likelihood of discharge to short-term or skilled nursing facilities.Conclusion: The current literature demonstrates the utility of frailty as a predictor of perioperative mortality and morbidity. Further research is needed to develop frailty screening measures in order to risk-stratify patients and optimize modifiable factors preoperatively.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Fu¹,

Sklar²,

Cohen³

et al. 2019

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…Recently, Pitts et al reported on a retrospective evaluation of frailty and outcomes in 410 patients that underwent HNC surgery between 2014 and 2017 . Frailty was measured using the Johns Hopkins Adjusted Clinical Groups (ACG) system and the mFI.…”

Section: Discussionmentioning

confidence: 99%

Frailty as a predictor of outcomes in patients undergoing head and neck cancer surgery

et al. 2019

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Objectives: To evaluate whether frailty and functional measures are predictors of perioperative complications and length of hospital stay (LOS) in patients undergoing head and neck cancer surgery.Study Design: Prospective study. Methods: Patients 50 years and older undergoing major head and neck cancer surgery between 2011 and 2015 preoperatively completed Fried's Frailty Index, Barthel Index, Lawton-Brody questionnaire and Vulnerable Elders Survey-13. Primary outcome measures were postoperative complications and LOS, which were analyzed using multivariable logistic and linear regression models.Results: There were 274 patients recruited (105 aged 50-64 and 169 aged 65 and older). Of these, 119, 132, and 23 were defined as non-frail, pre-frail, and frail, respectively. Frailty score and functional measures were not predictors of overall complications. In multivariable models, frailty score (odds ratio [OR] = 1.36; 95% confidence interval [CI], 1.04-1.78, P = .025) was a predictor of medical complications and Clavien-Dindo Grade III and higher complications independent of age and comorbidity. Higher frailty score (β = 1.07; 95% CI, 1.02-1.12, P = .0025) and less independence on the Lawton Brody (β = −0.08; 95% CI, −0.11 to −0.05, P < .001) and Barthel Index (β = −0.12; 95% CI, −0.19 to −0.06, P < .001) were predictors of increased LOS.Conclusions: Frailty was a predictor of type and severity of complications. Both frailty and measures of independence in activities of daily living were independent predictors of LOS. Frailty and functional assessment can help surgeons identify patients at risk of adverse postoperative outcomes and thus aid in counselling patients as well as identifying patients that may benefit from comprehensive geriatric assessment and targeted interventions.

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Preoperative Risk Index Among Patients Undergoing Thyroid or Parathyroid Surgery

Mascarella

Milad

Richardson

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Frailty represents a multidimensional syndrome that is increasingly being used to stratify risk in surgical patients. Current frailty risk models are limited among those undergoing thyroid or parathyroid surgery. OBJECTIVE To develop and compare preoperative risk indices to determine factors associated with short-term major postoperative adverse events in patients undergoing thyroid or parathyroid surgery. DESIGN, SETTING, AND PARTICIPANTS This cohort study evaluated 154 895 patients in the American College of Surgeons National Surgical Quality Improvement Program who underwent thyroid or parathyroid surgery from January 1, 2007, to December 31, 2016.EXPOSURES Preoperative frailty-related and surgical factors from a derivation cohort were evaluated using simple and multiple logistic regression. Variables potentially associated with postoperative adverse events were subsequently combined into a personalized preoperative Cervical Endocrine Surgery Risk Index (CESRI) and compared with existing risk models using the validation cohort. MAIN OUTCOMES AND MEASURESComposite variable of any major postoperative adverse event, including death, within 30 days of surgery. RESULTS Of the 154 895 operations reviewed, 3318 patients (2.1%; 2296 women and 1022 men; mean [SD] age, 56.1 [15.6] years) experienced a major postoperative adverse event, with 163 deaths (0.1%). Older age (age, Ն80 years: odds ratio [

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Frailty as a Predictor of Postoperative Outcomes among Patients with Head and Neck Cancer

Cited by 39 publications

References 12 publications

Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Frailty as a predictor of outcomes in patients undergoing head and neck cancer surgery

Preoperative Risk Index Among Patients Undergoing Thyroid or Parathyroid Surgery

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