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Association Between Modified Frailty Index and Postoperative Outcomes of Cricopharyngeal Myotomy
Afash Haleem1, David Herz1, Keshav D Kumar1
1Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Objective:
The modified 5-item frailty index (mFI-5) is a comorbidity-based risk stratification tool previously validated in patients undergoing several surgical procedures. This study investigates the association between mFI-5 score and cricopharyngeal myotomy (CM) complications.
Study Design:
Retrospective database review.
Setting:
US hospitals.
Methods:
The National Surgical Quality Improvement Program database was queried for patients who underwent CM between 2005 and 2018. mFI-5 score was determined by assigning 1 point for comorbidities including: diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent health status. Univariate and multivariable analyses were conducted to determine associations between mFI-5 score and postoperative complications.
Results:
A total of 1075 patients undergoing CMs were queried and stratified into the following groups: mFI = 0 (n = 412 [38.3%]), mFI = 1 (n = 452 [42.0%]), and mFI ≥ 2 (n = 211 [19.6%]). Univariate analysis showed association between higher mFI-5 scores with older age, higher American Society of Anesthesiologists Classification class, obesity, smoking, dyspnea, and systemic sepsis. Higher mFI-5 was associated with a greater proportion of cumulative surgical complications, cumulative medical complications, pneumonia, myocardial infarction, cumulative morbidity, readmissions, unplanned readmissions, and reoperations. Multivariable analyses found associations between greater mFI-5 score and cumulative morbidity (odds ratio [OR] = 1.95, confidence interval [CI]: 1.29-2.96, P = .002), any surgical complication (OR = 1.80, CI: 1.15-2.79, P = .010), readmission (OR = 1.81, CI: 1.01-3.26, P = .047), and reoperations (OR = 1.96, CI: 1.04-3.68, P = .037).
Conclusion:
Evaluating mFI-5 can help assess the risk of postoperative complications for patients undergoing CM.
Level Of Evidence:
Level 4.
Insights
The modified 5-item frailty index (mFI-5) can predict postoperative complications in patients undergoing cricopharyngeal myotomy (CM). Higher mFI-5 scores are linked to increased risks of morbidity, surgical complications, readmissions, and reoperations.
Area of Science:
- Surgical Outcomes Research
- Patient Risk Stratification
- Otolaryngology
Background:
- The modified 5-item frailty index (mFI-5) is a validated tool for assessing surgical patient risk.
- Cricopharyngeal myotomy (CM) is a procedure to treat swallowing disorders.
- The utility of mFI-5 in predicting CM complications is not well-established.
Purpose of the Study:
- To investigate the association between the modified 5-item frailty index (mFI-5) and postoperative complications following cricopharyngeal myotomy (CM).
- To determine if mFI-5 can serve as a risk stratification tool for CM patients.
Main Methods:
- Retrospective review of the National Surgical Quality Improvement Program database (2005-2018).
- Inclusion of 1075 patients who underwent cricopharyngeal myotomy (CM).
- Calculation of mFI-5 scores based on comorbidities (diabetes, hypertension, CHF, COPD, dependent health status) and statistical analysis of complication associations.
Main Results:
- Higher mFI-5 scores correlated with older age, higher ASA class, obesity, smoking, and dyspnea.
- Increased mFI-5 scores were associated with higher rates of cumulative surgical and medical complications, pneumonia, myocardial infarction, cumulative morbidity, readmissions, and reoperations.
- Multivariable analysis confirmed significant associations between higher mFI-5 scores and cumulative morbidity (OR=1.95), surgical complications (OR=1.80), readmission (OR=1.81), and reoperations (OR=1.96).
Conclusions:
- The modified 5-item frailty index (mFI-5) is a valuable tool for assessing the risk of postoperative complications in patients undergoing cricopharyngeal myotomy (CM).
- Preoperative evaluation of mFI-5 can aid in patient counseling and surgical planning for CM.
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