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The Predictive Value of a Modified Frailty Index on Perioperative Morbidity and Mortality Following Otologic Surgery
Kevin J Quinn1, Yuchi Ma1, Matthew Carli2
1Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
Objectives:
Recently, determinants of frailty have become an increasingly recognized perioperative risk stratification tool. This study examines the predictive value of a 5-factor modified frailty index (mFI-5) on perioperative morbidity and mortality in patients undergoing otologic surgery, with a subgroup analysis based on surgery site.
Study Design:
Cross-sectional analysis.
Setting:
National surgical quality improvement program dataset 2005-2019.
Patients:
Current procedural terminology (CPT) codes were used to identify patients undergoing all otologic surgeries.
Interventions:
Otologic surgeries as indicated by CPT codes, including external ear, middle ear/mastoid, implants, and inner ear/facial nerve subgroups.
Main Outcome Measures:
Primary outcomes examined in this study included rates of overall complications and life-threatening complications within 30 days after surgery. Overall complications included superficial surgical site infections (SSI), deep incisional SSI, readmission, deep vein thrombosis, life-threatening complications, and mortality. Life-threatening complications included those classified as Clavien-Dindo grade IV: cerebrovascular accident, mechanical ventilation for more than 48 hours, reintubation, pulmonary embolism, acute renal failure, cardiac arrest, and myocardial infarction.
Results:
A total of 16,859 patients who underwent otologic surgery were identified, resulting in a cohort that was 47.5% male with an average age of 47.6 years (17.1 SD). Multivariable regression analysis of the entire cohort demonstrated a score of 3 or more on the mFI-5 was independently predictive of all postoperative complications (odds ratio (OR): 2.02, P < 0.0001). However, subgroup analysis showed that only "external ear" surgery correlated with mFi-5 (OR 8.03, P = 0.013).
Conclusions:
Higher frailty scores as measured by the mFI-5 correlate with postoperative morbidity and mortality after otologic surgery, though subgroup analysis reveals an association only with cases performed on the external ear. These findings suggest that for most otologic surgery, the mFI-5 frailty score is not predictive of postoperative complications.
Insights
The 5-factor modified frailty index (mFI-5) predicts postoperative complications in otologic surgery patients. However, this association was only significant for external ear procedures, not other otologic surgeries.
Area of Science:
- Perioperative Medicine
- Surgical Risk Stratification
- Otologic Surgery Outcomes
Background:
- Frailty assessment is crucial for predicting surgical outcomes.
- The 5-factor modified frailty index (mFI-5) is a recognized tool for risk stratification.
- Its utility in otologic surgery requires further investigation.
Purpose of the Study:
- To evaluate the predictive value of the mFI-5 for perioperative morbidity and mortality in otologic surgery.
- To conduct a subgroup analysis based on the surgical site within otologic procedures.
Main Methods:
- Cross-sectional analysis of the National Surgical Quality Improvement Program dataset (2005-2019).
- Identification of 16,859 patients undergoing otologic surgery using Current Procedural Terminology codes.
- Multivariable regression analysis to assess the association between mFI-5 scores and postoperative complications.
Main Results:
- A mFI-5 score of 3 or higher independently predicted overall postoperative complications (OR: 2.02, P < 0.0001).
- Subgroup analysis revealed that only external ear surgery showed a significant correlation with mFI-5 (OR: 8.03, P = 0.013).
- No significant association was found between mFI-5 and complications for middle ear/mastoid, implant, or inner ear/facial nerve surgeries.
Conclusions:
- Elevated mFI-5 scores are linked to increased postoperative morbidity and mortality in otologic surgery patients.
- The predictive value of mFI-5 is limited to external ear surgeries within the otologic domain.
- The mFI-5 may not be a reliable predictor for most other otologic surgical procedures.
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