Frailty Is Superior to Age for Predicting Readmission, Prolonged Length of Stay, and Wound Infection in Elective Otology Procedures

Abstract

Objective: To determine the predictive ability of the 5-point modified frailty index relative to age in elective otology patients. Study Design: Retrospective database analysis. Setting: Multicenter, national database of surgical patients. Patients: We selected all elective surgical patients who received tympanoplasty, tympanomastoidectomy, mastoidectomy, revision mastoidectomy, and cochlear implant procedures from 2016 to 2019 from the National Surgical Quality Improvement database. Interventions: Therapeutic. Main Outcome Measures: Readmission rates, discharge disposition, reoperation rates, and extended length of hospital stay. Results: Utilizing receiver operating characteristics with area under the curve (AUC) analysis, nonrobust status was determined to be a superior predictor relative to age of readmission (AUC = 0.628 [p < 0.001] versus AUC = 0.567 [p = 0.047], respectively) and open wound infection relative to age (AUC = 0.636 [p = 0.024] versus AUC = 0.619 [p = 0.048], respectively). Nonrobust otology patients were more likely to have dyspnea at rest and an American Society of Anesthesiology score higher than 2 before surgery (odds ratios, 13.304 [95% confidence interval, 2.947-60.056; p < 0.001] and 7.841 [95% confidence interval, 7.064-8.704; p < 0.001], respectively). Conclusion: Nonrobust status was found to be a useful predictor of readmission and prolonged length of stay in patients undergoing elective otology procedures, which generally have low complication rate. Given the aging population and corresponding increase in otology disease, it is important to use age-independent risk stratification measures. Frailty may provide a useful risk stratification tool to select surgical candidates within the aging population.

Preoperative Frailty Risk in Cranioplasty Patients: Risk Analysis Index Predicts Adverse Outcomes

“…11,14 The mFI-5 has demonstrated superior discrimination in predicting postoperative outcomes compared with increasing patient age alone in a variety of neurosurgery, otolaryngology, orthopedic, urology, and plastic surgery publications. [15][16][17][18][19][20] More recently, the Risk Analysis Index-Administrative (RAI-A), a 14-question frailty score instrument, has been validated and may possess superior discriminatory ability compared with other frailty scales such as the mFI-5. [21][22][23] The RAI-A can readily be applied in under 1 minute in administrative research, at the patient's bedside or in clinic at the point of care, and follows a frailty conceptual framework.…”