Related Experiment Video
Updated: Jun 28, 2025
Author Spotlight: Assessing Surgical Frailty with Point-of-Care Ultrasound of Quadriceps Muscles
Published on: July 26, 2024
Modified Frailty Index Associates With Transoral Robotic Surgery Complications and Survival: A National Database
Amiti Jain1,2, Zachary N Goldberg1,2, Erin Briggs1,2
1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Objective:
The modified frailty index (mFI-5) is a National Surgical Quality Improvement Program-derived 5-factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI-5 is a valid predictive measure in the transoral robotic surgery (TORS) population.
Methods:
Retrospective study utilizing the TriNetX US-collaborative health records network querying for TORS patients. Cohorts were stratified by mFI-5 score which uses five ICD-10 codes: nonindependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching. Outcome measures included survival, infection, pneumonia, tracheostomy dependence, and percutaneous endoscopic gastrostomy dependence. Reported odds ratios were normalized to mFI-5 = 0.
Results:
A total of 9,081 patients were included in the final analysis. Greater mFI-5 scores predicted decreased survival and increased incidence of postoperative infection and pneumonia. Odds of 5-year mortality were 1.93 (p = 0.0003) for mFI-5 = 2 and 1.90 (p = 0.0002) for mFI-5 = 3. Odds of 2-year mortality were 1.25 (p = 0.0125) for mFI-5 = 1, 1.58 (p = 0.0002) for mFI-5 = 2, and 1.87 (p = 0.003) for mFI-5 = 3. Odds of postoperative infection were 1.51 (p = 0.02) for mFI-5 = 2 and 1.78 (p = 0.05) for mFI-5 = 3. Two-year odds of developing pneumonia were 1.69 (p = 0.0001) for mFI-5 = 2 and 2.84 (p < 0.0001) for mFI-5 = 3. Two-month odds of pneumonia were 1.50 (p = 0.0259) for mFI-5 = 2 and 2.55 (p = 0.0037) for mFI-5 = 3. mFI-5 = 4 or 5 had too few patients to analyze. Using polynomial regression to model age versus incident 5-year post-TORS death (R2 = 0.99), mFI-5 scores better predicted survival than age alone.
Conclusion:
This study demonstrates that mFI-5 predicts mortality, pneumonia, and postoperative infection independently of age.
Level Of Evidence:
4 Laryngoscope, 134:4278-4283, 2024.
Insights
The modified frailty index (mFI-5) accurately predicts mortality and complications in transoral robotic surgery (TORS) patients. Higher mFI-5 scores indicate increased risk, independent of patient age.
Area of Science:
- Surgical Oncology
- Robotic Surgery
- Geriatric Medicine
Background:
- The modified frailty index (mFI-5) is a validated tool for predicting outcomes in various surgical populations.
- Its utility in patients undergoing transoral robotic surgery (TORS) remains to be fully established.
Purpose of the Study:
- To evaluate the modified frailty index (mFI-5) as a predictive measure for outcomes in transoral robotic surgery (TORS).
- To assess the association between mFI-5 scores and mortality, infection, and pneumonia after TORS.
Main Methods:
- Retrospective analysis of 9,081 patients undergoing TORS using the TriNetX network.
- Patients were stratified by mFI-5 score (0-5) and propensity score matched for age.
- Outcomes included survival, infection, pneumonia, tracheostomy, and PEG dependence.
Main Results:
- Higher mFI-5 scores correlated with decreased survival and increased rates of postoperative infection and pneumonia.
- mFI-5 demonstrated a stronger predictive value for 5-year mortality than age alone.
- Significant associations were found between mFI-5 scores and 2-year mortality, postoperative infection, and pneumonia incidence.
Conclusions:
- The modified frailty index (mFI-5) is a valid and independent predictor of mortality, pneumonia, and infection in TORS patients.
- mFI-5 provides valuable prognostic information beyond patient age.
- This index can aid in risk stratification and patient counseling for TORS.
