Original Article

Frailty index: Intensive care unit complications in head and neck oncologic regional and free flap reconstruction

Corresponding Author

Nicholas B. Abt MD

[email protected]

orcid.org/0000-0002-2083-3523

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

Correspondence Nicholas B. Abt, Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114. Email: [email protected]Search for more papers by this author

Yanjun Xie BA,

Yanjun Xie BA

Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

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Sidharth V. Puram MD, PhD,

Sidharth V. Puram MD, PhD

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

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Jeremy D. Richmon MD,

Jeremy D. Richmon MD

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

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Mark A. Varvares MD,

Mark A. Varvares MD

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

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Nicholas B. Abt MD,

Corresponding Author

Nicholas B. Abt MD

[email protected]

orcid.org/0000-0002-2083-3523

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

Yanjun Xie BA,

Yanjun Xie BA

Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

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Sidharth V. Puram MD, PhD,

Sidharth V. Puram MD, PhD

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

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Jeremy D. Richmon MD,

Jeremy D. Richmon MD

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

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Mark A. Varvares MD,

Mark A. Varvares MD

Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

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First published: 27 April 2017

https://doi.org/10.1002/hed.24790

Citations: 42

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Abstract

Background

Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk.

Methods

Regional and free flap reconstructions of head and neck defects were collected from the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)-level complications were defined by Clavien-Dindo classification IV and analyzed with multivariable logistic regression.

Results

There were 266 flap reconstructions (126 regional and 140 free) with 86 (7.2%) Clavien-Dindo classification IV complications. As modified frailty index increased, a moderate correlation was demonstrated for Clavien-Dindo classification IV complications (R² = 0.30). Increasing modified frailty index score was correlated on linear regression with free versus regional flaps: Clavien-Dindo classification IV (R² = 0.09; 0.60), morbidity (R² = 0.04; 0.59), and mortality (R² = 0.07; 0.46), respectively. On multivariable analysis, the modified frailty index was associated with Clavien-Dindo classification IV complications for all flaps (odds ratio [OR] 4.38; 95% confidence interval [CI] 1.33-14.48) and free flaps (OR 6.60; 95%CI 1.02-42.52), but not regional flaps (OR 9.05; 95%CI 0.60-137.10).

Conclusion

The modified frailty index score is predictive of critical care support in head and neck resections necessitating reconstruction, specifically for free flaps.

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Volume39, Issue8

August 2017

Pages 1578-1585

Frailty index: Intensive care unit complications in head and neck oncologic regional and free flap reconstruction

Abstract

Background

Methods

Results

Conclusion

REFERENCES

Citing Literature

References

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Frailty index: Intensive care unit complications in head and neck oncologic regional and free flap reconstruction

Abstract

Background

Methods

Results

Conclusion

REFERENCES

Citing Literature

References

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