Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug 1;143(8):818-823.
doi: 10.1001/jamaoto.2017.0412.

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

Brandon Wachal  1 , Matthew Johnson  1 , Alissa Burchell  2 , Harlan Sayles  3 , Katherine Rieke  3 , Robert Lindau  4 , William Lydiatt  4 , Aru Panwar  1   4
Affiliations

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

Brandon Wachal et al. JAMA Otolaryngol Head Neck Surg. .

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures

Figure.
Figure.. Patient Selection Algorithm
CPT indicates Current Procedural Terminology; mFI, Modified Frailty Index.
See this image and copyright information in PMC

References

    1. Abt NB, Richmon JD, Koch WM, Eisele DW, Agrawal N. Assessment of the predictive value of the Modified Frailty Index for Clavien-Dindo grade IV critical care complications in major head and neck cancer operations. JAMA Otolaryngol Head Neck Surg. 2016;142(7):658-664. - PubMed
    1. Elegbede AI, Rybicki LA, Adelstein DJ, et al. . Oncologic and functional outcomes of surgical and nonsurgical treatment of advanced squamous cell carcinoma of the supraglottic larynx. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1111-1117. - PubMed
    1. Gourin CG, Frick KD. National trends in laryngeal cancer surgery and the effect of surgeon and hospital volume on short-term outcomes and cost of care. Laryngoscope. 2012;122(1):88-94. - PubMed
    1. Adams P, Ghanem T, Stachler R, Hall F, Velanovich V, Rubinfeld I. Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery. JAMA Otolaryngol Head Neck Surg. 2013;139(8):783-789. - PubMed
    1. American College of Surgeons. About the ACS risk calculator. ACS NSQIP Surgical Risk Calculator Web site. http://riskcalculator.facs.org/RiskCalculator/about.html. Accessed August 31, 2016.