Frailty index: Intensive care unit complications in head and neck oncologic regional and free flap reconstruction

Head Neck. 2017 Aug;39(8):1578-1585. doi: 10.1002/hed.24790. Epub 2017 Apr 27.

Abstract

Background: Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk.

Methods: Regional and free flap reconstructions of head and neck defects were collected from the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)-level complications were defined by Clavien-Dindo classification IV and analyzed with multivariable logistic regression.

Results: There were 266 flap reconstructions (126 regional and 140 free) with 86 (7.2%) Clavien-Dindo classification IV complications. As modified frailty index increased, a moderate correlation was demonstrated for Clavien-Dindo classification IV complications (R2 = 0.30). Increasing modified frailty index score was correlated on linear regression with free versus regional flaps: Clavien-Dindo classification IV (R2 = 0.09; 0.60), morbidity (R2 = 0.04; 0.59), and mortality (R2 = 0.07; 0.46), respectively. On multivariable analysis, the modified frailty index was associated with Clavien-Dindo classification IV complications for all flaps (odds ratio [OR] 4.38; 95% confidence interval [CI] 1.33-14.48) and free flaps (OR 6.60; 95%CI 1.02-42.52), but not regional flaps (OR 9.05; 95%CI 0.60-137.10).

Conclusion: The modified frailty index score is predictive of critical care support in head and neck resections necessitating reconstruction, specifically for free flaps.

Keywords: Clavien; National Surgical Quality Improvement Program (NSQIP); cancer; critical care; flap; frailty; frailty index; free flap; head and neck; mortality; otolaryngology; outcomes; readmission; reconstruction; reoperation.

MeSH terms

  • Activities of Daily Living
  • Aged
  • Critical Care
  • Female
  • Frailty*
  • Free Tissue Flaps / adverse effects*
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Complications* / mortality
  • Postoperative Complications* / surgery
  • Reconstructive Surgical Procedures / statistics & numerical data
  • Regression Analysis
  • Reoperation / statistics & numerical data