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Association Between Modified Frailty Index and Postoperative Outcomes of Tracheostomies
Sree Chinta1, Afash Haleem1, Dhiraj R Sibala1
1Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NewJersey, USA.
Objective:
The 5-item modified frailty index (mFI-5) has been used to stratify patients based on the risk of postoperative complications in several surgical procedures but has not yet been done in tracheostomies. This study investigates the association between the mFI-5 score and tracheostomy complications.
Study Design:
Retrospective database review.
Setting:
United States hospitals.
Methods:
The National Surgical Quality Improvement Program database was queried for tracheostomy patients between 2005 and 2018. The mFI-5 was calculated for each patient by assigning 1 point for each of the following comorbidities: diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functionally dependent health status. Univariate and multivariable analyses were conducted to determine associations between the mFI-5 score and postoperative complications.
Results:
A total of 4438 patients undergoing tracheostomies were queried and stratified into the following groups: mFI = 0 (N = 1741 [39.2%], mFI = 1 (N = 1720 [38.8%]), mFI = 2 (N = 726 [16.4%]), and mFI of 3 or higher (N = 251 [5.7%]). Univariate analysis showed that patients with higher mFI-5 scores had a greater proportion of smoking, dyspnea, obesity, steroid use, emergency cases, complications, reoperations, and mortality (P < .001). Multivariable analyses found associations between mFI-5 score and any complication (odds ratio [OR]: 1.49, 95% confidence interval [CI]: 1.03-2.16, P = .035), mortality (OR: 2.32, 95% CI: 1.15-4.68, P = .019), and any medical complication (OR: 2.75, 95% CI: 1.88-4.02, P < .001).
Conclusion:
This study suggests an association between the mFI-5 score and postoperative complications in tracheostomies. mFI-5 score can be used to stratify tracheostomy patients by operative risk.
Insights
The 5-item modified frailty index (mFI-5) is associated with increased postoperative complications and mortality in tracheostomy patients. This index can effectively stratify patients by operative risk.
Area of Science:
- Surgical Outcomes
- Patient Risk Stratification
- Anesthesiology
Background:
- The 5-item modified frailty index (mFI-5) is utilized for risk stratification in various surgical procedures.
- Its utility in predicting complications following tracheostomies has not been previously established.
Purpose of the Study:
- To investigate the association between the mFI-5 score and the incidence of postoperative complications in patients undergoing tracheostomy.
- To determine if the mFI-5 can serve as a tool for stratifying operative risk in this patient population.
Main Methods:
- A retrospective review of the National Surgical Quality Improvement Program database from 2005 to 2018 was performed.
- The mFI-5 was calculated for 4438 tracheostomy patients based on five key comorbidities.
- Univariate and multivariable analyses were employed to assess the relationship between mFI-5 scores and adverse outcomes.
Main Results:
- Higher mFI-5 scores correlated with increased rates of smoking, dyspnea, obesity, steroid use, emergency procedures, complications, reoperations, and mortality (P < .001).
- Multivariable analysis revealed significant associations between higher mFI-5 scores and any complication (OR: 1.49, P = .035), mortality (OR: 2.32, P = .019), and medical complications (OR: 2.75, P < .001).
Conclusions:
- The mFI-5 score demonstrates a significant association with postoperative complications and mortality in patients undergoing tracheostomy.
- The mFI-5 is a valuable tool for stratifying operative risk among tracheostomy patients.
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