Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B285
Session Name: Poster Session
Frailty Indices as a Predictor of Postoperative Disposition in Head and Neck Patients Undergoing Free Flap Surgery
Alexandra Vacaru, BS1; Nihal Punjabi, BS2; Roy W Qu, MD3; Jacob Hauser, BS1; Traeden Wilson, MD3; Jared Inman, MD3; 1Loma Linda University School of Medicine; 2Case Western Reserve School of Medicine; 3Loma Linda University Health, Department of Otolaryngology-Head and Neck SurgeryPurpose: To evaluate a tertiary care center’s experience with head and neck free flap surgeries over a ten-year period to determine frailty, patient postoperative disposition, complications, and length of stay to better educate patients and patient families on postoperative outcomes.
Background: Determining operative risk for patients undergoing head and neck free flap reconstruction has been challenging due to complex comorbidities that complicate objective assessments. Frailty indices offer a quantifiable measurement tool, with a focus on functional status and deficits that accumulate with age. This study aims to compare American Society of Anesthesiologists’ (ASA) physical status classification system and three different frailty indices (Charlson Comorbidity Index [CCI], 5-factor modified frailty index [mFI-5], 11-factor modified frailty index [mFI-11]) to assess their predictive value for patient postoperative disposition following head and neck free flap surgery.
Methods: A retrospective chart review of 711 patients who underwent head and neck free flap surgery from September 1, 2014, to September 1, 2024, was conducted. Data collection included demographics (age, sex, race), medical history (smoking status, BMI), and surgical factors (ASA score, surgery length, and comorbidities relating to CCI, mFI-5, and mFI-11). Immediate surgical complications and postoperative outcomes (return to OR, hospital and ICU length of stay, 30-day readmission, blood transfusion, mortality) were also collected. Indices were calculated on a 37-point, 5-point, and 11-point scale for CCI, mFI-5, and mFI-11, respectively. The primary outcome was patient disposition, categorized as either being discharged to non-home or home settings. Odds ratios (OR); 95% confidence interval (CI) of patient disposition were analyzed by univariate binomial regression. The Mann-Whitney U test assessed differences in index scores between non-home and home discharges. Multivariate logistic regression evaluated patient disposition, incorporating surgical complications and frailty indices, while Akaike information criteria (AIC) identified the best-fitting frailty index.
Results: ASA (OR, 1.84; 95% CI, 1.33–2.54), CCI (OR, 1.47; 95% CI, 1.33–1.63), mFI-5 (OR, 1.47; 95% CI, 1.23–1.75), and mFI-11 (OR, 1.37; 95% CI, 1.18–1.60) were statistically significant in predicting patient disposition to non-home settings compared to home settings (p<.001). The CCI frailty index exhibited the lowest AIC. ICU length of stay was also statistically significant in predicting patient disposition (p<.001). The OR of predicting patient disposition to non-home settings trended downwards with increased age (age 65+ [OR, 2.83; 95% CI, 2.05–3.90], age 75+ [OR, 2.35; 95% CI, 1.67–3.32], age 85+ [OR, 2.01; 95% CI, 1.05–3.84]). This highlights the importance of evaluating frailty, rather than relying solely on numerical age.
Conclusions: This study highlights the importance of frailty indices and ASA, particularly CCI, in predicting postoperative disposition for patients undergoing head and neck free flap surgeries. The CCI demonstrated the best fit for the data, suggesting it is a valuable tool for assessing operative risk in this population. When assessing patients or planning treatments, it’s crucial to evaluate functional status and overall health instead of relying solely on numerical age. These findings aim to improve patient and family education regarding postoperative expectations, recovery, and outcomes.
