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

Abstract

The mFI is predictive of postoperative critical care support after surgery for head and neck cancer. Specifically, increases in mFIs were strongly associated with CDIV complications for glossectomy, mandibulectomy, and laryngectomy. Classifying patients by their functional status using the mFI may help predict outcomes after head and neck oncologic surgery.

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

“…Our study adds to the growing literature demonstrating the importance of frailty in predicting postoperative complications independent of age or comorbidity status. We have previously identified the frailty index as a predictor of postoperative critical care support; however, it remained unclear how reconstruction affected these results. This study is the first to show frailty is highly predictive of ICU‐level complications in flap reconstruction, especially free flap reconstruction.…”

“…Our study adds to the growing literature demonstrating the importance of frailty in predicting postoperative complications independent of age or comorbidity status. We have previously identified the frailty index as a predictor of postoperative critical care support 16 When separated into free and regional flaps, regional flaps had a moderate to strong correlation on linear regression between modified frailty index and Clavien-Dindo classification IV (R 2 5 0.60), morbidity (R 2 5 0.59), and mortality (R 2 5 0.46) outcomes. However, free flaps had low correlation on linear regression with modified frailty index for all 3 outcomes of Clavien-Dindo classification IV (R 2 5 0.09), morbidity (R 2 5 0.04), and mortality (R 2 5 0.07).…”

“…The modified frailty index is a derivative of the CSHA, 7 which has been validated in numerous surgical fields, 2,[8][9][10][11][12][13][14] including head and neck surgery. 15,16 The modified frailty index has been shown to be a predictor of severe complications and mortality in head and neck surgery; however, it is unclear how reconstruction affects these complications. Therefore, we sought to assess the modified frailty index's predictive value of Clavien-Dindo classification level IV (intensive care unit [ICU]) complications and morbidity and mortality after major head and neck oncologic reconstruction.…”

Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction

“…This saving in blood products has significant cost implications and potentially could reduce transfusion-associated morbidity. [11][12][13] Still, preoperative anemia is a known risk factor for surgical and medical complications in various surgical disciplines, [14][15][16][17][18][19] and a randomized clinical trial data is required to robustly guide perioperative transfusion practices.…”

Prediction of mortality and morbidity in head and neck cancer patients 80 years of age and older undergoing surgery

“…In a 2009 retrospective review of 530 head and neck cancer patients of all ages, presence of dysphagia was associated with a greater than two times risk of postoperative complications and mortality when compared to patients without dysphagia, and was 50% more predictive of outcome than weight loss . In addition to being a symptom of advanced head and neck cancer, presence of dysphagia is associated with functional decline from aging as well as reflects the severity of underlying comorbid conditions such as stroke, Parkinson disease, traumatic brain injury, and dementia, among other conditions. Additionally, dysphagia is associated with poorer outcomes in the elderly such as aspiration pneumonia, malnutrition, and premature mortality .…”