Inconsistent Associations of Modified Frailty Index-5 With Adverse Head and Neck Reconstruction Outcomes

IF 2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Laryngoscope Pub Date : 2025-01-27 DOI:10.1002/lary.32008

Doruk Orgun MD, Caroline C. Bay BA, Kristine M. Carbullido MD, Aaron M. Wieland MD, Brett F. Michelotti MD, Samuel O. Poore MD, PhD

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Abstract

Objectives

To investigate the consistency of associations between modified frailty index-5 (mFI-5) and postoperative adverse outcomes in head and neck cancer (HNC) reconstruction.

Methods

American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2017 to 2022 was utilized to identify HNC patients undergoing locoregional or microvascular free tissue transfers. Kaplan–Meier estimates and multivariable Cox regression analyses were utilized to compare risk of infections, bleeding, readmissions, reoperations, major adverse cardiovascular events (MACE), and mortality within the first postoperative month for each mFI-5 score with mFI-5 = 0 as reference. Further analyses investigated associations between individual mFI-5 components and the outcomes of interest.

Results

We included 5,573 patients (median age: 64; 31.5% female), 63% (n = 3,519) of whom underwent microvascular free tissue transfers. Unadjusted univariate analyses associated higher mFI-5 scores with longer hospital stays. In locoregional tissue transfers, adjusted hazard ratios (aHRs) for reoperation were 1.37 (p = 0.03) for mFI-5 = 1 and 2.19 (p = 0.03) for mFI-5 ≥ 3. In microvascular free tissue transfers, aHRs for MACE were 1.93 (p = 0.04) for mFI-5 = 2 and 6.53 (p < 0.001) for mFI-5 ≥ 3, while aHRs for mortality was 3.88 (p = 0.04) for mFI-5 ≥ 3. No associations were observed between increasing mFI-5 scores and increased relative risk of infection, bleeding, or readmission. Individual component analysis associated congestive heart failure with aHRs of 3.92 (1.84–8.35; p < 0.001) for MACE and 5.30 (2.03–13.88; p < 0.001) for mortality. Additionally, COPD was associated with an aHR of 1.39 (1.16–1.67; p < 0.001) for infections.

Conclusion

The associations of higher mFI-5 scores with postoperative adverse outcomes following oncoplastic head and neck reconstruction were inconsistent and possibly driven by individual effects of its components.

Level of Evidence

3 Laryngoscope, 135:2342–2352, 2025

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改良虚弱指数-5 与不良头颈部重建结果的关系不一致。

目的：探讨改良脆性指数-5 （mFI-5）与头颈癌（HNC）重植术术后不良结局之间相关性的一致性。方法：利用2017 - 2022年美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库，对接受局部或微血管游离组织移植的HNC患者进行鉴定。以mFI-5 = 0为参照，采用Kaplan-Meier估计和多变量Cox回归分析比较各mFI-5评分患者术后第一个月内感染、出血、再入院、再手术、主要心血管不良事件（MACE）和死亡率的风险。进一步的分析调查了单个mFI-5成分与研究结果之间的关系。结果：我们纳入了5573例患者(中位年龄：64岁；31.5%女性),63% （n = 3519）的患者接受了微血管游离组织移植。未经调整的单变量分析将较高的mFI-5评分与较长的住院时间联系起来。在局部组织转移中，mFI-5 = 1时再手术的校正危险比（aHRs）为1.37 (p = 0.03)， mFI-5≥3时再手术的校正危险比为2.19 （p = 0.03）。在微血管游离组织移植中，mFI-5 = 2时MACE的ahr为1.93 (p = 0.04)， mFI-5评分为6.53 (p)。结论：mFI-5评分较高与肿瘤头颈部重建术后不良结局的相关性不一致，可能是由其组成部分的个体影响所致。证据等级：III级（3级）喉镜，2025。

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来源期刊

Laryngoscope 医学-耳鼻喉科学

CiteScore

6.50

自引率

7.70%

发文量

500

审稿时长

2-4 weeks

期刊介绍： The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope. • Broncho-esophagology • Communicative disorders • Head and neck surgery • Plastic and reconstructive facial surgery • Oncology • Speech and hearing defects