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Original Investigation
August 2017

Association of Modified Frailty Index Score With Perioperative Risk for Patients Undergoing Total Laryngectomy

Author Affiliations
  • 1Division of Head and Neck Surgery, University of Nebraska Medical Center, Omaha
  • 2Medical Student, College of Medicine, University of Nebraska Medical Center, Omaha
  • 3College of Public Health, University of Nebraska Medical Center, Omaha
  • 4Department of Head and Neck Surgical Oncology, Nebraska Methodist Hospital, Omaha
JAMA Otolaryngol Head Neck Surg. 2017;143(8):818-823. doi:10.1001/jamaoto.2017.0412
Key Points

Question  Does the Modified Frailty Index accurately measure the risk for postoperative complications, length of hospitalization, and discharge disposition for patients undergoing total laryngectomy?

Findings  This population-based analysis of 595 patients in the American College of Surgeons National Surgical Quality Improvement Program data registry indicated that a high level of baseline frailty in patients undergoing total laryngectomy is associated with (1) a significantly increased risk for overall complications, (2) prolonged postoperative hospitalization, and (3) an increased likelihood of requiring postdischarge skilled care.

Meaning  Physiologic decline as measured by the Modified Frailty Index is a significant determinant of possible postoperative outcomes following total laryngectomy.

Abstract

Importance  Objective preoperative risk assessment tools, such as the Modified Frailty Index (mFI), may inform patient and physician decision making when considering total laryngectomy. Estimation of outcomes may help to set realistic expectations about recovery and outcomes and facilitate optimal resource management.

Objective  To evaluate the association between the mFI score as a measure of frailty and outcomes following total laryngectomy.

Design, Setting, and Participants  Retrospective evaluation using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), a risk- and case-mix–adjusted national quality assessment program. The ACS NSQIP database identified 595 patients who underwent total laryngectomy between 2006 and 2012. Patients were assessed for demographics and comorbidity and were stratified on the basis of calculated mFI score. Outcomes, including postoperative complications, length of hospitalization, and discharge destination, were evaluated as a function of increasing frailty using multivariable logistic regression and Cox proportional hazards regression models.

Main Outcomes and Measures  Risk of postoperative complications, length of hospitalization, and discharge disposition.

Results  After exclusion of patients who experienced significant deviation from standard care protocols and those with missing or incomplete data, 343 individuals were included in the analysis. Of these, 278 (81.0%) were men, and the mean age was 63 years (95% CI, 61.9-64.4 years). Increasing frailty resulted in a nonlinear but progressive rise in incidence of postoperative adverse events. Overall, 96 (28.0%) patients experienced a postoperative complication, and patients with an mFI score of 3 or higher were more likely to develop postoperative complications than were patients with an mFI score of 0 (50.0% vs 16.7%; OR, 3.83; 95% CI, 1.72- 8.51). Patients in the highest frailty group experienced a longer mean duration of hospitalization (14.2 vs 9.5 days; difference, 4.7; 95% CI, 1.3-8.1 days) and were more likely to require skilled care after discharge (33.3% vs 3.2%; difference, 30.1%; 95% CI, 7.4%-52.9%).

Conclusions and Relevance  An mFI score of 3 or higher is associated with increased risk for postoperative complications, longer hospitalization, and need for postdischarge skilled care following total laryngectomy. The mFI provides a personalized risk assessment to better inform patients, physicians, and payers when planning a total laryngectomy.

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