Introduction: Frailty refers to a state of reduced physiologic reserves and functional decline. We sought to analyse if frailty predicted increased morbidity and mortality following major head and neck surgical resection.
Methods: We performed a retrospective study of patients undergoing major mucosal head and neck surgical resection over a 2-year period. Patients were classified as non-frail or frail based on 5-item modified frailty index scores.
Results: There were 310 patients included with 77 (24.8%) classified as frail. Most patients were male (70.7%) and had a history of smoking (79.4%) while 151 patients (48.7%) were older than 65 at time of surgery. Most surgeries related to oral cavity or oropharyngeal subsites (227 patients, 73.2%) and 150 patients (48.4%) had microvascular free tissue reconstruction. On multivariable analysis, frail patients were more likely to suffer a Clavien-Dindo grade III complication (OR 3.47, 95% CI 1.82 – 6.62, p<0.001), Clavien-Dindo grade IV complication (OR 6.23, 95% CI 2.55 – 15.20, p<0.001). Ninety-day mortality was not increased in frail patients (OR 1.22, 95% CI 0.23 – 6.39, p=0.817).
Conclusions: Frail patients suffer significantly greater post-operative morbidity following major mucosal head and neck resection. Pre-operative identification of these patients may allow identification of patients requiring increased perioperative supports.
Eoin F. Cleere1, Claire Doherty1, Justin Hintze1, Conrad Timon1, John Kinsella1, Paul Lennon1, Conall Fitzgerald1
1 Department of Otolaryngology Head & Neck surgery, St James’s Hospital, Dublin