The modified 5-item frailty index is a predictor of perioperative risk in head and neck microvascular reconstruction: An analysis of 3795 cases

Haug, Valentin; Kauke, Martin; Foroutanjazi, Sina; Diehm, Yannick; Pomahač, Bohdan

doi:10.1016/j.amjoto.2021.103121

Cited by 23 publications

(43 citation statements)

References 23 publications

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“…Due to the low rates of these events, no analysis was performed to estimate the risk of these complications. 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: 68%

“…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%

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

Hatch

Surdell

Gard

et al. 2022

Laryngoscope Investig Oto

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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.

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Section: Discussionmentioning

confidence: 68%

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

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“…A growing number of largely retrospective studies have suggested that frailty may also be associated with poor outcomes following head and neck surgery 30,31 . As such, the aim of the present systematic review and meta‐analysis was to determine whether frailty was associated with poor outcomes following head and neck oncologic surgery.…”

Section: Introductionmentioning

confidence: 99%

“…28,29 A growing number of largely retrospective studies have suggested that frailty may also be associated with poor outcomes following head and neck surgery. 30,31 As such, the aim of the present systematic review and metaanalysis was to determine whether frailty was associated with poor outcomes following head and neck oncologic surgery. The primary aim of this study was to evaluate the risk of 30-day postoperative morbidity and 30-day mortality among frail, compared to their nonfrail counterparts.…”

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confidence: 99%

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

2022

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Background: Frailty refers to a patient's reduced capacity to withstand stressors due to a reduction in physiologic reserves. We assessed the impact of frailty on outcomes following head and neck surgery.Methods: We performed a systematic review in accordance with the PRISMA guidelines. Meta-analysis was performed using the Mantel-Haenszel method.Results: Fourteen studies incorporating 182 059 patients were included in qualitative synthesis with 15 953 (8.8%) of patients deemed as frail. Metaanalysis incorporating nine studies demonstrated that frailty is associated with an increased 30 day postoperative morbidity (OR 2.74; 95% CI 1.98-3.80; p < 0.01) and meta-analysis with six studies suggested increased 30-day mortality (OR 2.94; 95% CI 2.62-3.31; p < 0.01). Preliminary meta-analyses between two and five studies suggested that frail patients had reduced overall survival and were more likely to be discharged to a nonhome location or readmitted within 30 days.Conclusions: Frailty appears to be associated with poor short-term outcomes following head and neck surgery and may improve understanding of an individual patient's peri-operative risk.

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“…26 In microvascular head and neck reconstruction, Panayi et al showed that increases in mFI-5 scores were associated with greater postoperative complications, longer hospital stays, and higher rates of mortality and unplanned readmission. 27 In a 2021 study by Dammeyer et al, patients with mFI-5 scores of 2 or greater who underwent mastectomies demonstrated higher rates of postoperative complications. 28 This agrees with our findings that incremental increases in preoperative mFI-5 score are associated with a greater likelihood of developing complications postoperatively.…”

Section: Discussionmentioning

confidence: 97%

Frailty is the New Age: A Retrospective Study of Modified Frailty Index for Preoperative Risk Assessment in Autologous Breast Reconstruction

Chow

Karius

Broderick

et al. 2023

J Reconstr Microsurg

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Background Age is a poor predictor of postoperative outcomes in breast reconstruction necessitating new methods for risk-stratifying patients preoperatively. The 5-item modified frailty index (mFI-5) is a validated measure of frailty which assesses patients' global health. The purpose of this study was to compare the effectiveness of mFI-5 and age as independent predictors of 30-day postoperative complications following autologous breast reconstruction. Methods Patients who underwent autologous breast reconstruction between 2005 and 2019 were identified from the American College of Surgeons National Surgical Quality Improvement Program. Patients were stratified based on presence of major, minor, both minor and major, and no complications. Univariate and multivariate logistic regression were performed to determine the predictive power of mFI-5, age, and other preoperative risk factors for development of minor and major 30-day postoperative complications in all patients and stratified by flap type. Results A total of 25,215 patients were included: 20,366 (80.8%) had no complications, 2,009 (8.0%) had minor complications, 1,531 (6.1%) had major complications, and 1,309 (5.2%) had both minor and major complications. Multivariate regression demonstrated age was not a predictor of minor (odds ratio [OR]: 1.0, p = 0.045), major (OR: 1.0, p = 0.367), or both minor and major (OR: 1.0, p = 0.908) postoperative complications. mFI-5 was a significant predictor of minor complications for mFI-5 scores 1 (OR: 1.3, p < 0.001), 2 (OR: 1.8, p < 0.001), and 3 (OR: 2.8, p = 0.043). For major complications, mFI-5 was a significant predictor for scores 1 (OR: 1.2, p = 0.011) and 2 (OR: 1.3, p = 0.03). Conclusion Compared with age, mFI-5 scores were better predictors of 30-day postoperative complications following autologous breast reconstruction regardless of flap type. Additionally, higher mFI-5 scores were associated with increased odds of minor and major complications. Our findings indicate that reconstructive breast surgeons should consider using the mFI-5 in lieu of age to risk-stratify patients prior to autologous breast reconstruction surgery.

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The modified 5-item frailty index is a predictor of perioperative risk in head and neck microvascular reconstruction: An analysis of 3795 cases

Cited by 23 publications

References 23 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

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

Frailty is the New Age: A Retrospective Study of Modified Frailty Index for Preoperative Risk Assessment in Autologous Breast Reconstruction

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