Cervical paraspinal skeletal muscle index outperforms frailty indices to predict postoperative adverse events in operable head and neck cancer with microvascular reconstruction

Mascarella, Marco A.; Gardiner, Lauren; Patel, Terral; Vendra, Varun; Khan, Nayel; Kergoat, Marie‐Jeanne; Kubik, Mark; Solari, Mario G.; Snyderman, Carl H.; Traylor, Katie; Sridharan, Shaum

doi:10.1002/micr.30848

Cited by 11 publications

(8 citation statements)

References 36 publications

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“…Recently, the mFI‐5 has been studied for predicting negative outcomes in microsurgical reconstruction (Jain et al, 2021; Mascarella et al, 2022). Jain et al (2021) conducted a retrospective analysis using the NSQIP database, focusing on 11,852 breast cancer patients who underwent free‐flap breast.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, only a small portion (4%) of the study population exhibited an mFI‐5 score exceeding 2. In a separate study by Mascarella et al (2022) the mFI‐5 was compared to the cervical paraspinal skeletal muscle index within a prospective cohort of 127 treatment‐naïve head and neck cancer patients undergoing microvascular reconstruction. Similar to our own results, the authors did not find the mFI‐5 to be predictive of postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

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Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction

Deldar,

Huffman,

Bovill

et al. 2023

Microsurgery

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BackgroundIdentifying at‐risk patients for complications remains challenging in patients with chronic lower extremity (LE) wounds receiving free tissue transfer (FTT) for limb salvage. The modified‐5 frailty index (mFI‐5) has been utilized to predict postoperative complications, yet it has not been studied in this population. The aim of this study was to determine the utility of the mFI‐5 in predicting adverse postoperative outcomes.MethodsPatients ≥60 years, who underwent LE FTT reconstruction at a single institution from 2011 to 2022, were retrospectively reviewed. Patient characteristics, mFI‐5, and postoperative outcomes were collected. Cohorts were divided by an mFI‐5 score of <2 or ≥2.ResultsA total of 115 patients were identified, of which 71.3% (n = 82) were male, 64.3% (n = 74) had a mFI‐5 score of ≥2, and 35.7% (n = 41) had a score <2. The average age and body mass index were 67.8 years and 28.7 kg/m2, respectively. The higher mFI‐5 cohort had lower baseline albumin levels (3.0 vs. 4.0 g/dL, p = .015) and higher hemoglobin A1c levels (7.4 vs. 5.8%, p < .001). The postoperative length of stay was longer in the higher mFI‐5 cohort (18 vs. 13.4 days, p = .003). The overall flap success was 96.5% (n = 111), with no difference between cohorts (p = .129). Postoperative complications were comparable between cohorts (p = .294). At a mean follow‐up of 19.8 months, eight patients (7.0%) underwent amputation, and 91.3% (n = 105) were ambulatory.ConclusionHigh microsurgical success rates can be achieved in comorbid patients with high frailty indexes who undergo FTT for limb salvage. A multidisciplinary team approach may effectively mitigate negative outcomes in elderly, frail patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction

Deldar,

Huffman,

Bovill

et al. 2023

Microsurgery

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“…SMI outperformed the modified Frailty index and preoperative anaesthesia risk assessment index to predict postoperative adverse events: for the prediction of Clavien-Dindo grade 3+ complications the areas under the curve for SMI, modified Frailty index and preoperative anaesthesia risk assessment index were 0.76, 0.56 and 0.50 (p < .05), respectively. The overall accuracy of the SMI to predict a Clavien-Dindo grade 3+ complication, fistula, or prolonged stay in hospital was 84.8% ( 104 ).…”

Section: Sarcopenia and Frailtymentioning

confidence: 99%

“…Mascarella et al. ( 104 ) investigated predictive factors for postoperative adverse events in 127 treatment-naïve HNC patients undergoing surgery with microvascular reconstruction. For SMM assessment CSMA of the paravertebral muscles at C3 or L3 was measured on CT. Low SMI was independently associated with severe complications (Clavien-Dindo Grade 3+ events; OR 2.80, 95% CI 1.18–6.99), particularly fistula (OR 6.10, 95% CI of 1.53–24.3), when adjusted for multiple factors.…”

Section: Sarcopenia and Frailtymentioning

confidence: 99%

Measurement of Sarcopenia in Head and Neck Cancer Patients and Its Association With Frailty

et al. 2022

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In head and neck cancer (HNC) there is a need for more personalized treatment based on risk assessment for treatment related adverse events (i.e. toxicities and complications), expected survival and quality of life. Sarcopenia, defined as a condition characterized by loss of skeletal muscle mass and function, can predict adverse outcomes in HNC patients. A review of the literature on the measurement of sarcopenia in head and neck cancer patients and its association with frailty was performed. Skeletal muscle mass (SMM) measurement only is often used to determine if sarcopenia is present or not. SMM is most often assessed by measuring skeletal muscle cross-sectional area on CT or MRI at the level of the third lumbar vertebra. As abdominal scans are not always available in HNC patients, measurement of SMM at the third cervical vertebra has been developed and is frequently used. Frailty is often defined as an age-related cumulative decline across multiple physiologic systems, with impaired homeostatic reserve and a reduced capacity of the organism to withstand stress, leading to increased risk of adverse health outcomes. There is no international standard measure of frailty and there are multiple measures of frailty. Both sarcopenia and frailty can predict adverse outcomes and can be used to identify vulnerable patients, select treatment options, adjust treatments, improve patient counselling, improve preoperative nutritional status and anticipate early on complications, length of hospital stay and discharge. Depending on the definitions used for sarcopenia and frailty, there is more or less overlap between both conditions. However, it has yet to be determined if sarcopenia and frailty can be used interchangeably or that they have additional value and should be used in combination to optimize individualized treatment in HNC patients.

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“…[14–16] Besides, some studies revealed that pretreatment skeletal muscle index (SMI) is significantly related to poor prognosis of cancer patients. [17–21] However, the association between pretreatment SMI and survival of pancreatic cancer patients remains unclear up to now.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of pretreatment skeletal muscle index in pancreatic carcinoma patients: A meta-analysis

Liao

Xie

et al. 2023

Medicine

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Background: The association between pretreatment skeletal muscle index (SMI) and long-term survival of pancreatic carcinoma patients remains unclear up to now. Methods: The PubMed, Web of Science and EMBASE databases were searched up to March 1, 2022 for relevant studies. The primary and secondary outcomes were overall survival and progression-free survival, respectively. The hazard ratios (HRs) and 95% confidence intervals (CIs) were combined to assess the relationship between pretreatment SMI and prognosis of pancreatic carcinoma patients. All statistical analysis was conducted by STATA 15.0 software. Results: Twenty retrospective studies involving 3765 patients were included. The pooled results demonstrated that lower pretreatment SMI was significantly related to poorer overall survival (HR = 1.42, 95% CI: 1.25–1.62, P < .001) and progression-free survival (HR = 1.41, 95% CI: 1.08–1.84, P = .012). Besides subgroup analysis based on the treatment (non-surgery vs surgery) and tumor stage (advanced vs early stage) showed similar results. Conclusion: Pretreatment SMI could serve as a promising and reliable prognostic factor for pancreatic carcinoma patients and lower pretreatment SMI predicted worse prognosis.

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Cervical paraspinal skeletal muscle index outperforms frailty indices to predict postoperative adverse events in operable head and neck cancer with microvascular reconstruction

Cited by 11 publications

References 36 publications

Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction

Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction

Measurement of Sarcopenia in Head and Neck Cancer Patients and Its Association With Frailty

Prognostic value of pretreatment skeletal muscle index in pancreatic carcinoma patients: A meta-analysis

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