Background and Objective: Frailty has been previously demonstrated in the literature to have a strong association with poor outcomes in surgical patients. To our knowledge, frailty has not been evaluated in microvascular reconstructive head and neck patients. The objective of this study is to determine frailty as a predictor of morbidity and mortality in microvascular reconstructive head and neck patients by using the modified frailty index (mFI). It is hypothesized that increasing modified frailty index is a positive predictor for poor post-operative outcomes, including mortality, significant complications and increased length of stay.
Methods and Analysis: Retrospective analysis of 106 patients who underwent microvascular free flap reconstructive surgeries in the otolaryngology department between 2013 – 2017. Patients included underwent anterolateral, forearm, fibula or serratus free flaps. All free flaps were performed by surgeons within the otolaryngology department of two major tertiary-care hospitals. Modified Frailty Index was determined for each patient and primary outcomes were recorded including mortality and Clavien-Dindo Grade IV Complications. Secondary outcomes include flap failure, return to OR, length of ICU stay, length of hospital stay, and readmission rate.
Results: 106 patients met inclusion criteria. Average age of patients was 61. The mean mFI was 0.09 and the range was 0 to 0.55. Of those patients, 12 patients had an mFI greater than or equal to 0.28. The remaining 94 patients had mFI < 0.28. Patients with greater mFI were more likely to have post-operative Grade IV complications (30% vs 10%), longer ICU stay (6.3 days vs. 5.4) and total length of hospital stay (15.9 days vs. 12.9). As a secondary measure, patients with mFI greater than 0.28 were also more likely to return to the OR (30% vs 20%). Mortality was not associated with increased modified frailty index.
Conclusion: Modified frailty index is associated with increased morbidity in this retrospective analysis of microvascular reconstructive head and neck patients. The mFI in head and neck reconstructive patients can be a useful tool in preoperative planning and risk stratification.