Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: The use of Transoral robotic surgery (TORS) has revolutionized the management of oropharyngeal cancers by offering a minimally invasive alternative to traditionally open surgical approaches. TORS affords benefits such as reduced postoperative pain, shorter hospital stays, and improved functional outcomes. As the population ages and use of robotic surgery increases, more elderly patients with diminished physiological reserves are being offered TORS. Assessment of patient frailty has become crucial for predicting surgical risks and optimizing perioperative care. The Risk Analysis Index (RAI) has been validated as a robust tool for predicting postoperative adverse outcomes across various surgical specialties. However, its predictive value in the context of TORS has not been explored. This study evaluates the effectiveness of the RAI in predicting postoperative complications, extended length of stay (eLOS), and non-home discharge in patients undergoing TORS.
Methods: Patients undergoing transoral robotic surgery for oropharyngeal cancers were identified from the 2010–2020 NSQIP datasets, utilizing selection criteria and CPT/ICD codes as established by Su et al. (2016). The Risk Analysis Index frailty scores were calculated using established criteria, and patients were stratified into prefrail (RAI: 21–30), frail (RAI: 31–40), and severely frail (RAI: 41+). Univariate analyses were conducted on preoperative and postoperative variables, and significant preoperative factors were controlled for in multivariate analysis. Receiver operating characteristic (ROC) curves were generated to evaluate the discriminative ability of the RAI in predicting postoperative adverse outcomes.
Results: In a cohort of 1,634 patients undergoing TORS for oropharyngeal cancers, the majority were male (75.2%) and White (78.2%). Higher [dJ(2] [AW3] RAI scores were significant independent predictors of extended length of stay (OR: 8.237; 95% CI: 2.139–31.719; p = 0.002), non-home discharge (OR: 7.128; 95% CI: 1.610–31.563; p < 0.001), Clavien-Dindo grade II complications (OR: 3.335; 95% CI: 1.475–7.536; p = 0.004), and grade IV complications (OR: 4.617; 95% CI: 2.005–10.630; p < 0.001). ROC analysis demonstrated that the RAI had significant discriminative ability for predicting eLOS (C-statistic: 0.630; p < 0.001), non-home discharge (C-statistic: 0.652; p = 0.028), and Clavien-Dindo grade IV complications (C-statistic: 0.622; p < 0.001).
Conclusion: The Risk Analysis Index is a significant predictor of postoperative adverse outcomes in patients undergoing transoral robotic surgery for oropharyngeal cancers. Higher RAI scores were associated with increased risks of extended length of stay, non-home discharge, and higher-grade postoperative complications. The RAI demonstrated significant discriminative ability in predicting these outcomes, underscoring its utility as a preoperative risk assessment tool in this patient population. Incorporating the RAI into clinical practice may enhance perioperative decision-making, patient goals-of-care, and resource allocation for prevention of poor long-term outcomes. Further research is warranted to validate these findings and to integrate the RAI into standardized preoperative assessment protocols for TORS candidates.