The association of frailty with morbidity and mortality following major mucosal head and neck surgery.

Autor: Cleere EF; Department of Head and Neck Surgery, St James's Hospital, Dublin, Ireland. Electronic address: eoincleere@rcsi.ie., Hintze JM; Department of Head and Neck Surgery, St James's Hospital, Dublin, Ireland., Doherty C; Department of Head and Neck Surgery, St James's Hospital, Dublin, Ireland., Timon CVI; Department of Head and Neck Surgery, St James's Hospital, Dublin, Ireland., Kinsella J; Department of Head and Neck Surgery, St James's Hospital, Dublin, Ireland., Lennon P; Department of Head and Neck Surgery, St James's Hospital, Dublin, Ireland., Fitzgerald CWR; Department of Head and Neck Surgery, St James's Hospital, Dublin, Ireland.
Jazyk: angličtina
Zdroj: Oral oncology [Oral Oncol] 2024 Sep 07; Vol. 159, pp. 107021. Date of Electronic Publication: 2024 Sep 07.
DOI: 10.1016/j.oraloncology.2024.107021
Abstrakt: Objectives: Frailty refers to a state of reduced physiological reserve and functional decline. We sought to analyse whether frailty, assessed using the 5-item modified frailty index (5mFI), was associated with increased morbidity and mortality following major mucosal head and neck surgery.
Materials and Methods: We performed a retrospective study of patients undergoing major mucosal head and neck surgical resection over a 2-year period. Potential confounding variables were controlled by way of multivariable regression analysis.
Results: There were 310 patients included with 77 (24.8 %) classified as frail. Most patients were male (219/310, 70.7 %), had a history of smoking (246/310, 79.4 %) and 151 patients (48.7 %) were older than 65 at time of surgery. Most surgeries related to oral cavity or oropharyngeal subsites (227/310, 73.2 %) and 150 patients (48.4 %) underwent microvascular free tissue reconstruction. On multivariable analysis, frail patients were more likely to suffer adverse outcomes such as a return to theatre (OR 3.47, 95 % CI 1.82-6.62, p < 0.001), a Clavien-Dindo grade IV complication (OR 6.23, 95 % CI 2.55-15.20, p < 0.001) or medical complications, such as respiratory complications (OR 2.61, 95 % CI 1.45-4.69; p = 0.001) or delirium (OR 5.05, 95 % CI 2.46-10.33; p < 0.001). Additionally, hospital length of stay was increased among frail patients (ß 16.46 days, 95 % CI 9.85-23.07 days; p < 0.001). Neither 90-day nor 1-year post-operative mortality was increased in frail patients.
Conclusion: Frailty assessed using the 5mFI was associated with greater post-operative morbidity, but not mortality following major mucosal head and neck surgery.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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