Modified 5-item frailty index may predict risk in head, neck microvascular reconstruction

The modified frailty index 5 (mFI-5)—a scale based on the five variables diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure, and functional dependency—has been shown to be a valid predictor of surgical outcomes.

In this study, authors, Adriana C.Panayi and colleagues from the Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA sought to evaluate the ability of the mFI-5 to predict the postoperative outcomes of head and neck microvascular reconstruction.

A total of 5323 cases of microvascular reconstruction were identified, of which 3795 were head and neck cases that provided parameters necessary to calculate the mFI-5. The groups were compared in terms of demographics and comorbidities. Post-operative outcomes assessed included mortality, average operative time and length of hospital stay, surgical and medical complications, and non-home discharge.

The findings seen were-

1. Increases in the mFI were associated with longer hospitalization periods (10.5 ± 7.5 days in mFI 0 vs 14.9 ± 15.4 in mFI ≥ 3; p < 0.0001) higher rates of mortality (1% in mFI 0 vs 3.1% in mFI ≥ 3; p = 0.02), reoperation (15.4% in mFI 0 vs 17.2% in mFI ≥ 3; p = 0.002) and unplanned readmission (7.6% in mFI 0 vs 18.8% in mFI ≥ 3; p = 0.001).

2. Rates of any complications (p < 0.0001), as well as surgical (p < 0.002) and medical (p < 0.0001) complications specifically were higher with greater mFI scores.

3. Higher mFI scores also predicted decreased home discharge (p < 0.0001).

4. Differences remained significant on multivariate analysis and subgroup analysis by age.

Therefore, the authors concluded that "the mFI-5 is a significant predictor of risk in microvascular head and neck reconstruction. Subgroup analysis by age highlights that the tool can help identify younger patients who are frail and hence at risk. Through appropriate pre-operative identification of frail patients surgeons can prospectively modify their operative and discharge planning as well as post-operative support."