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

Abt, Nicholas B.; Xie, Yanjun; Puram, Sidharth V.; Richmon, Jeremy D.; Varvares, Mark A.

doi:10.1002/hed.24790

Cited by 46 publications

(75 citation statements)

References 29 publications

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“…Our PubMed search yielded nine studies evaluating the association between a frailty measure and perioperative outcome(s) in patients undergoing HNC surgery. Seven studies (77%) used a population‐based database such as NSQIP, NIS (Nationwide Inpatient Sample), or Nationwide Readmissions Database. In total, three frailty measures were analyzed: 1) the mFI (5 studies, 56%), 2) Johns Hopkins Adjusted Clinical Groups (ACG) frailty‐defining diagnosis indicator (4 studies, 44%), and 3) Groningen Frailty Indicator (GFI) (1 study, 11%).…”

Section: Resultsmentioning

confidence: 99%

“…Five studies examined frailty using the mFI in head and neck surgery patients in the NSQIP outcome database. Adams et al assessed the ability of the mFI to predict mortality and complications in 6,727 inpatients between the ages of 16 to 90 years (mean 54.7 years) undergoing non‐major HNS (i.e., thyroidectomy, parotidectomy, neck dissection, tonsillectomy, and palatopharyngoplasty).…”

Section: Resultsmentioning

confidence: 99%

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Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Fu¹,

Sklar²,

Cohen³

et al. 2019

The Laryngoscope

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Objective: Frailty has emerged as an important determinant of many health outcomes across various surgical specialties. We examined the published literature reporting on frailty as a predictor of perioperative outcomes in head and neck cancer (HNC) surgery.Study Design: Narrative review with limited electronic database search and cross-referencing of included studies. Methods: PubMed was searched from inception until June 2019 to capture studies evaluating an association between frailty and perioperative outcomes among patients undergoing HNC surgery. Primary outcomes included mortality and morbidity, whereas secondary outcomes included in-hospital cost, length of stay, readmission, and discharge disposition.Results: We identified nine series examining frailty as a predictor of outcomes in HNC. The majority of studies (77%) identified patients using a large population-based database such as the National Surgical Quality Improvement Project or National Inpatient Sample. Frailty measures applied in the HNC surgery literature include the modified frailty index, Groningen Frailty Indicator, and John Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Most studies demonstrated a significant association between frailty and perioperative outcomes, including mortality, perioperative complications, and Clavien-Dindo grade IV complications. Furthermore, frailty was associated with greater length of hospital stay, readmission rate, and likelihood of discharge to short-term or skilled nursing facilities.Conclusion: The current literature demonstrates the utility of frailty as a predictor of perioperative mortality and morbidity. Further research is needed to develop frailty screening measures in order to risk-stratify patients and optimize modifiable factors preoperatively.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Fu¹,

Sklar²,

Cohen³

et al. 2019

The Laryngoscope

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“…Cardiovascular and pulmonary complications are increased with transfusion in the HN-free flap population, suggesting that regional pedicled flap may be less systemically taxing postoperatively. 5,10 Transfused pedicled flap patients received an average of 2.7 units of blood, but PM and SM flaps did not demonstrate different transfusion requirements. Transfusion requirements of pedicled flaps were similar to HN free flaps reviewed at our institution, which received 2.5 units of red blood cells.…”

Section: Discussionmentioning

confidence: 97%

“…Medical complications, including MI, pneumonia, CVA, DVT/PE, pulmonary edema, CHF exacerbation, and others were not increased with transfusion. Cardiovascular and pulmonary complications are increased with transfusion in the HN‐free flap population, suggesting that regional pedicled flap may be less systemically taxing postoperatively …”

Section: Discussionmentioning

confidence: 99%

Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction

et al. 2018

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Objective Blood product utilization is monitored to prevent unnecessary transfusions. Head‐and‐neck pedicled flap reconstruction transfusion‐related outcomes were assessed. Methods One hundred and thirty‐six pedicled flap patients were reviewed: 64 supraclavicular artery island flaps (SCAIF), 57 pectoralis major (PM) flaps, and 15 submental (SM) flaps. Outcome parameters included flap‐related complications, medical complications, length of stay (LOS), and flap survival. Multivariable logistic regression analyses were performed. Multivariable logistic regression analyses were performed to adjust for relevant pre‐ and perioperative factors. Results Of all head‐and‐neck pedicled flap patients included in our analyses (n = 136), 40 (29.4%) received blood transfusions. The average pretransfusion hematocrit (Hct) was 24.3% ± 0.5%, with 2.65 ± 0.33 units transfused and a posttransfusion Hct increase of 5.0% ± 0.6%. Transfusion rates differed with PM (47.4%), SCAIF (17.2%), and SM (13.3%) flaps (P < 0.005). Patients undergoing PM reconstruction trended toward higher transfusion requirements (PM 2.89 ± 0.47 units, SC 2.18 ± 0.28 units, and SM 2.00 ± 0.0 units), with transfusion occurring later in the postoperative course (4.9 ± 1.3 days vs. 2.4 ± 0.1 days for all other flaps; P = 0.08). Infection, dehiscence, fistula, or medical complications were not different. Transfusion thresholds of Hct < 21 versus Hct < 27 exhibited no difference in LOS, flap‐survival, or medical/flap‐related complications. Conclusion Transfusion is not associated with surgical or medical morbidity following head and neck pedicled flap reconstruction. There were no differences in outcomes between transfusion triggers of Hct < 21 versus Hct < 27, suggesting that a more conservative transfusion trigger may not precipitate adverse patient complications. Our data recapitulate findings in free flap patients and warrant further investigation of transfusion practices in head and neck flap reconstruction. Level of Evidence 4. Laryngoscope, 128:E409–E415, 2018

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“…Intravenous iron administration to patients with anemic cancer has been shown to significantly increase hemoglobin levels independently from the precise anemia mechanism . Preoperative iron therapy may increase quality of life, performance status, and reduce the need for erythropoietin‐stimulating agents and/or blood transfusions . As little as 1000 mg ferric carboxymaltose as a single injection 14 days prior to surgery has shown hematocrit increases of 3.6%‐4.2% .…”

Section: Discussionmentioning

confidence: 99%

Preoperative anemia displays a dose‐dependent effect on complications in head and neck oncologic surgery

et al. 2019

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Introduction Anemia's effect on head and neck surgical complications is unknown. Methods Head and neck cancer operations were acquired from the 2006 to 2013 American College of Surgeons National Surgical Quality Improvement Program databases. Anemia was defined as <39% or <36% hematocrit in men and women, respectively. Multivariable logistic regression analyses were performed. Results Major head and neck surgery patients had a 44.2% anemia incidence (n = 527 of 1193). Anemic patients had increased complication rates (27.1%) and mortality (2.1%) vs non‐anemic patients at 19.8% (P = .003) and 0.5% (P = .009), respectively. There was a significant difference in morbidity odds with hematocrit >27% (odds ratio [OR] = 1.09) vs <27% (OR = 4.22). Complication odds were further increased with hematocrit between 24% and 27% (OR = 8.94). There were increased rates of wound dehiscence (6.6% vs 2.7%, P < .001), pneumonia (8.5% vs 4.7%, P = .006), and myocardial infarction (1.7% vs 0.3%, P = .01) in anemic vs non‐anemic patients. Conclusion Anemia was associated with increased morbidity at hematocrit <27%. An inverse dose‐dependent effect of decreasing hematocrit was observed for overall morbidity.

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

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

Cited by 46 publications

References 29 publications

Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction

Preoperative anemia displays a dose‐dependent effect on complications in head and neck oncologic surgery

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