Frailty as a Predictor of Outcomes After Fibula Free Flap for Head and Neck Reconstruction: A Multi-Institutional Analysis Using the mFI-5

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2026-10-09 DOI:10.1002/micr.70301

Jia Wei Tee, Dany Matar, Lorenzo Puppi, Thomas Schaschinger, Tobias Niederegger, Iman Ghanad, Leonard Knoedler, Samuel Knoedler, Dennis P. Orgill, Henri Kreiker, Carsten Rendenbach, Max Heiland, Gabriel Hundeshagen, Adriana C. Panayi

{"title":"Frailty as a Predictor of Outcomes After Fibula Free Flap for Head and Neck Reconstruction: A Multi-Institutional Analysis Using the mFI-5","authors":"Jia Wei Tee, Dany Matar, Lorenzo Puppi, Thomas Schaschinger, Tobias Niederegger, Iman Ghanad, Leonard Knoedler, Samuel Knoedler, Dennis P. Orgill, Henri Kreiker, Carsten Rendenbach, Max Heiland, Gabriel Hundeshagen, Adriana C. Panayi","doi":"10.1002/micr.70301","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Chronological age inadequately reflects physiologic vulnerability in older adults undergoing complex reconstruction. Frailty, quantified by the 5-item Modified Frailty Index (mFI-5), may better stratify perioperative risk in fibula free flap (FFF) reconstruction for head and neck defects, but its impact remains underdefined.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective cohort study of 406 adults undergoing FFF reconstruction (ACS-NSQIP, 2009–2023) evaluated the association between mFI-5 and 30-day postoperative outcomes. Multivariable logistic regression identified independent predictors of medical and surgical complications.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Higher mFI-5 scores were associated with increased medical complications (14.1% mFI-5 = 0 vs. 34.3% mFI-5 = 2; <i>p</i> = 0.02), including pneumonia and myocardial infarction. mFI-5 = 1 (aOR 1.84; 95% CI, 1.01–3.47) and mFI-5 = 2 (aOR 3.45; 95% CI, 1.38–8.57) independently predicted medical complications; mFI-5 = 2 also predicted surgical complications (aOR 2.27; 95% CI, 1.00–5.43).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Frailty is a stronger predictor of postoperative morbidity than chronological age. Incorporating frailty assessment may enhance risk stratification and perioperative decision-making.</p>\n </section>\n </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 7","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Microsurgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/micr.70301","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Chronological age inadequately reflects physiologic vulnerability in older adults undergoing complex reconstruction. Frailty, quantified by the 5-item Modified Frailty Index (mFI-5), may better stratify perioperative risk in fibula free flap (FFF) reconstruction for head and neck defects, but its impact remains underdefined.

Methods

A retrospective cohort study of 406 adults undergoing FFF reconstruction (ACS-NSQIP, 2009–2023) evaluated the association between mFI-5 and 30-day postoperative outcomes. Multivariable logistic regression identified independent predictors of medical and surgical complications.

Results

Higher mFI-5 scores were associated with increased medical complications (14.1% mFI-5 = 0 vs. 34.3% mFI-5 = 2; p = 0.02), including pneumonia and myocardial infarction. mFI-5 = 1 (aOR 1.84; 95% CI, 1.01–3.47) and mFI-5 = 2 (aOR 3.45; 95% CI, 1.38–8.57) independently predicted medical complications; mFI-5 = 2 also predicted surgical complications (aOR 2.27; 95% CI, 1.00–5.43).

Conclusions

Frailty is a stronger predictor of postoperative morbidity than chronological age. Incorporating frailty assessment may enhance risk stratification and perioperative decision-making.

查看原文本刊更多论文

虚弱是腓骨游离皮瓣头颈部重建后预后的预测因素：一项使用mFI-5的多机构分析

背景：实际年龄不能充分反映经历复杂重建的老年人的生理脆弱性。由5项改良衰弱指数（mFI-5）量化的衰弱可以更好地分层腓骨游离皮瓣（FFF）重建头颈部缺损的围手术期风险，但其影响仍不明确。方法对406例接受FFF重建的成人进行回顾性队列研究（ACS-NSQIP, 2009-2023），评估mFI-5与术后30天预后的关系。多变量logistic回归确定了内科和外科并发症的独立预测因素。结果mFI-5评分越高，并发症发生率越高（14.1% mFI-5 = 0, 34.3% mFI-5 = 2, p = 0.02），包括肺炎和心肌梗死。mFI-5 = 1 （aOR 1.84, 95% CI 1.01 ~ 3.47）和mFI-5 = 2 （aOR 3.45, 95% CI 1.38 ~ 8.57）独立预测医学并发症；mFI-5 = 2也可预测手术并发症（aOR 2.27; 95% CI, 1.00-5.43）。结论：与实足年龄相比，虚弱是术后发病率的一个更强的预测因子。纳入衰弱评估可以加强风险分层和围手术期决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.