Eoin F. Cleere, Justin M. Hintze, Claire Doherty, Conrad V.I. Timon, John Kinsella, Paul Lennon, Conall W.R. Fitzgerald
{"title":"头颈部粘膜大手术后体弱与发病率和死亡率的关系。","authors":"Eoin F. Cleere, Justin M. Hintze, Claire Doherty, Conrad V.I. Timon, John Kinsella, Paul Lennon, Conall W.R. Fitzgerald","doi":"10.1016/j.oraloncology.2024.107021","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>Frailty refers to a state of reduced physiological reserve and functional decline. We sought to analyse whether frailty, assessed using the 5-item modified frailty index (5mFI), was associated with increased morbidity and mortality following major mucosal head and neck surgery.</p></div><div><h3>Materials and Methods</h3><p>We performed a retrospective study of patients undergoing major mucosal head and neck surgical resection over a 2-year period. Potential confounding variables were controlled by way of multivariable regression analysis.</p></div><div><h3>Results</h3><p>There were 310 patients included with 77 (24.8 %) classified as frail. Most patients were male (219/310, 70.7 %), had a history of smoking (246/310, 79.4 %) and 151 patients (48.7 %) were older than 65 at time of surgery. Most surgeries related to oral cavity or oropharyngeal subsites (227/310, 73.2 %) and 150 patients (48.4 %) underwent microvascular free tissue reconstruction. On multivariable analysis, frail patients were more likely to suffer adverse outcomes such as a return to theatre (OR 3.47, 95 % CI 1.82–6.62, p < 0.001), a Clavien-Dindo grade IV complication (OR 6.23, 95 % CI 2.55–15.20, p < 0.001) or medical complications, such as respiratory complications (OR 2.61, 95 % CI 1.45–4.69; p = 0.001) or delirium (OR 5.05, 95 % CI 2.46–10.33; p < 0.001). Additionally, hospital length of stay was increased among frail patients (ß 16.46 days, 95 % CI 9.85–23.07 days; p < 0.001). Neither 90-day nor 1-year post-operative mortality was increased in frail patients.</p></div><div><h3>Conclusion</h3><p>Frailty assessed using the 5mFI was associated with greater post-operative morbidity, but not mortality following major mucosal head and neck surgery.</p></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"159 ","pages":"Article 107021"},"PeriodicalIF":4.0000,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The association of frailty with morbidity and mortality following major mucosal head and neck surgery\",\"authors\":\"Eoin F. Cleere, Justin M. Hintze, Claire Doherty, Conrad V.I. Timon, John Kinsella, Paul Lennon, Conall W.R. Fitzgerald\",\"doi\":\"10.1016/j.oraloncology.2024.107021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>Frailty refers to a state of reduced physiological reserve and functional decline. We sought to analyse whether frailty, assessed using the 5-item modified frailty index (5mFI), was associated with increased morbidity and mortality following major mucosal head and neck surgery.</p></div><div><h3>Materials and Methods</h3><p>We performed a retrospective study of patients undergoing major mucosal head and neck surgical resection over a 2-year period. Potential confounding variables were controlled by way of multivariable regression analysis.</p></div><div><h3>Results</h3><p>There were 310 patients included with 77 (24.8 %) classified as frail. Most patients were male (219/310, 70.7 %), had a history of smoking (246/310, 79.4 %) and 151 patients (48.7 %) were older than 65 at time of surgery. Most surgeries related to oral cavity or oropharyngeal subsites (227/310, 73.2 %) and 150 patients (48.4 %) underwent microvascular free tissue reconstruction. On multivariable analysis, frail patients were more likely to suffer adverse outcomes such as a return to theatre (OR 3.47, 95 % CI 1.82–6.62, p < 0.001), a Clavien-Dindo grade IV complication (OR 6.23, 95 % CI 2.55–15.20, p < 0.001) or medical complications, such as respiratory complications (OR 2.61, 95 % CI 1.45–4.69; p = 0.001) or delirium (OR 5.05, 95 % CI 2.46–10.33; p < 0.001). Additionally, hospital length of stay was increased among frail patients (ß 16.46 days, 95 % CI 9.85–23.07 days; p < 0.001). Neither 90-day nor 1-year post-operative mortality was increased in frail patients.</p></div><div><h3>Conclusion</h3><p>Frailty assessed using the 5mFI was associated with greater post-operative morbidity, but not mortality following major mucosal head and neck surgery.</p></div>\",\"PeriodicalId\":19716,\"journal\":{\"name\":\"Oral oncology\",\"volume\":\"159 \",\"pages\":\"Article 107021\"},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2024-09-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Oral oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1368837524003397\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Oral oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1368837524003397","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
The association of frailty with morbidity and mortality following major mucosal head and neck surgery
Objectives
Frailty refers to a state of reduced physiological reserve and functional decline. We sought to analyse whether frailty, assessed using the 5-item modified frailty index (5mFI), was associated with increased morbidity and mortality following major mucosal head and neck surgery.
Materials and Methods
We performed a retrospective study of patients undergoing major mucosal head and neck surgical resection over a 2-year period. Potential confounding variables were controlled by way of multivariable regression analysis.
Results
There were 310 patients included with 77 (24.8 %) classified as frail. Most patients were male (219/310, 70.7 %), had a history of smoking (246/310, 79.4 %) and 151 patients (48.7 %) were older than 65 at time of surgery. Most surgeries related to oral cavity or oropharyngeal subsites (227/310, 73.2 %) and 150 patients (48.4 %) underwent microvascular free tissue reconstruction. On multivariable analysis, frail patients were more likely to suffer adverse outcomes such as a return to theatre (OR 3.47, 95 % CI 1.82–6.62, p < 0.001), a Clavien-Dindo grade IV complication (OR 6.23, 95 % CI 2.55–15.20, p < 0.001) or medical complications, such as respiratory complications (OR 2.61, 95 % CI 1.45–4.69; p = 0.001) or delirium (OR 5.05, 95 % CI 2.46–10.33; p < 0.001). Additionally, hospital length of stay was increased among frail patients (ß 16.46 days, 95 % CI 9.85–23.07 days; p < 0.001). Neither 90-day nor 1-year post-operative mortality was increased in frail patients.
Conclusion
Frailty assessed using the 5mFI was associated with greater post-operative morbidity, but not mortality following major mucosal head and neck surgery.
期刊介绍:
Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck.
Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.