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Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery.
JAMA Otolaryngol Head Neck Surg. 2013 Aug 01; 139(8):783-9.JO

Abstract

IMPORTANCE

The increasing number of elderly and comorbid patients undergoing surgical procedures raises interest in better identifying patients at increased risk of morbidity and mortality, independent of age. Frailty has been identified as a predictor of surgical complications.

OBJECTIVE

To establish the implications of frailty as a predictor of morbidity and mortality in inpatient otolaryngologic operations.

DESIGN

Retrospective review of medical records.

SETTING

National Surgical Quality Improvement Program (NSQIP) participating hospitals.

PATIENTS

NSQIP participant use files were used to identify 6727 inpatients who underwent operations performed by surgeons specializing in otolaryngology between 2005 and 2010. The study sample was 50.3% male and 10.2% African American, with a mean (range) age of 54.7 (16-90) years.

MAIN OUTCOMES AND MEASURES

A previously described modified frailty index (mFI) was calculated on the basis of NSQIP variables. The effect of increasing frailty on morbidity and mortality was evaluated using univariate analysis. Multivariate logistic regression was used to compare mFI with age, ASA, and wound classification. RESULTS The mean (range) mFI was 0.07 (0-0.73). As the mFI increased from 0 (no frailty-associated variables) to 0.45 (5 of 11) or higher, mortality risk increased from 0.2% to 11.9%. The risk of Clavien-Dindo grade IV complications increased from 1.2% to 26.2%. The risk of all complications increased from 9.5% to 40.5%. All results were significant at P < .001. In a multivariate logistic regression model to predict mortality or serious complication, mFI became the dominant significant predictor.

CONCLUSIONS AND RELEVANCE

The mFI is significantly associated with morbidity and mortality in this retrospective survey. Additional study with prospective analysis and external validation is needed. The mFI may provide an improved understanding of preoperative risk, which would facilitate perioperative optimization, risk stratification, and counseling related to outcomes.

Authors+Show Affiliations

Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23949353

Citation

Adams, Peter, et al. "Frailty as a Predictor of Morbidity and Mortality in Inpatient Head and Neck Surgery." JAMA Otolaryngology-- Head & Neck Surgery, vol. 139, no. 8, 2013, pp. 783-9.
Adams P, Ghanem T, Stachler R, et al. Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery. JAMA Otolaryngol Head Neck Surg. 2013;139(8):783-9.
Adams, P., Ghanem, T., Stachler, R., Hall, F., Velanovich, V., & Rubinfeld, I. (2013). Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery. JAMA Otolaryngology-- Head & Neck Surgery, 139(8), 783-9. https://doi.org/10.1001/jamaoto.2013.3969
Adams P, et al. Frailty as a Predictor of Morbidity and Mortality in Inpatient Head and Neck Surgery. JAMA Otolaryngol Head Neck Surg. 2013 Aug 1;139(8):783-9. PubMed PMID: 23949353.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery. AU - Adams,Peter, AU - Ghanem,Tamer, AU - Stachler,Robert, AU - Hall,Francis, AU - Velanovich,Vic, AU - Rubinfeld,Ilan, PY - 2013/8/17/entrez PY - 2013/8/21/pubmed PY - 2013/12/16/medline SP - 783 EP - 9 JF - JAMA otolaryngology-- head & neck surgery JO - JAMA Otolaryngol Head Neck Surg VL - 139 IS - 8 N2 - IMPORTANCE: The increasing number of elderly and comorbid patients undergoing surgical procedures raises interest in better identifying patients at increased risk of morbidity and mortality, independent of age. Frailty has been identified as a predictor of surgical complications. OBJECTIVE: To establish the implications of frailty as a predictor of morbidity and mortality in inpatient otolaryngologic operations. DESIGN: Retrospective review of medical records. SETTING: National Surgical Quality Improvement Program (NSQIP) participating hospitals. PATIENTS: NSQIP participant use files were used to identify 6727 inpatients who underwent operations performed by surgeons specializing in otolaryngology between 2005 and 2010. The study sample was 50.3% male and 10.2% African American, with a mean (range) age of 54.7 (16-90) years. MAIN OUTCOMES AND MEASURES: A previously described modified frailty index (mFI) was calculated on the basis of NSQIP variables. The effect of increasing frailty on morbidity and mortality was evaluated using univariate analysis. Multivariate logistic regression was used to compare mFI with age, ASA, and wound classification. RESULTS The mean (range) mFI was 0.07 (0-0.73). As the mFI increased from 0 (no frailty-associated variables) to 0.45 (5 of 11) or higher, mortality risk increased from 0.2% to 11.9%. The risk of Clavien-Dindo grade IV complications increased from 1.2% to 26.2%. The risk of all complications increased from 9.5% to 40.5%. All results were significant at P < .001. In a multivariate logistic regression model to predict mortality or serious complication, mFI became the dominant significant predictor. CONCLUSIONS AND RELEVANCE: The mFI is significantly associated with morbidity and mortality in this retrospective survey. Additional study with prospective analysis and external validation is needed. The mFI may provide an improved understanding of preoperative risk, which would facilitate perioperative optimization, risk stratification, and counseling related to outcomes. SN - 2168-619X UR - https://www.unboundmedicine.com/medline/citation/23949353/Frailty_as_a_predictor_of_morbidity_and_mortality_in_inpatient_head_and_neck_surgery_ L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2013.3969 DB - PRIME DP - Unbound Medicine ER -