Frailty adversely affects outcome following free-flap reconstruction in patients with head and neck cancer

Frailty is a multisystem aging-associated syndrome characterised by physiological decline and increased vulnerability to stressors. There will be a need for elderly, and possibly frail patients, to undergo complex and lengthy free-flap reconstruction for large head-and-neck defects. The purpose of this study was to evaluate the impact that frailty has on post-operative complications, functional outcomes, and overall survival in this cohort.

A retrospective case-control study of patients undergoing free-flap reconstruction of head-and-neck defects was carried out between 2021-2023. 159 cases were included. Demographic data were collected for each patient, and comorbidities were recorded, including variables contributing to the 5 mFI frailty index. Disease and treatment characteristics were recorded, along with post-operative complications, return to theatre or intensive care unit (ICU), return to eating, and overall survival.

The mean age of the cohort was 62.11. Patients were characterised as frail in 25.2% of cases. There was a statistically significant increase in respiratory complications (p=0.038), delirium (p<0.001), return to theatre (p=0.010), return to ICU (p<0.001), and delayed return to eating (p=0.028) in the frail cohort. Multivariate analysis demonstrated an increase in post-operative complications in frail patients, in larynx/hypopharynx malignancies, and in patients with a tracheostomy (p=0.005, 0.039, and 0.043 respectively). Overall survival was negatively influenced by age >65 years (p=0.014) and male sex (p=0.042) on multivariate analysis.

Data from this study demonstrated a higher risk of post-operative complications and return to theatre or ICU in patients undergoing free-flap reconstruction of complex head-and-neck defects with higher frailty scores, but were not associated with differences in overall survival.