Modified 5-Item Frailty Index and Postoperative Outcomes Following Parotidectomy for Malignancy

Objective

Frailty is a predictor of poor outcomes following surgery for malignancy. Our study investigates the association between the modified 5-item frailty index (mFI-5) and postoperative outcomes following parotidectomy for malignancy.

Study Design

Cross-sectional database study.

Setting

National Surgical Quality Improvement Program (NSQIP).

Methods

The 2005–2018 NSQIP was retrospectively queried for patients undergoing parotidectomy for malignancy. Cases were stratified by the modified 5-item frailty index (mFI-5), which was calculated by the presence of 5 comorbidities: hypertension requiring medication, diabetes mellitus, congestive heart failure in the last 30 days, lung pathology, and functional health status. Univariate and multivariate analyses were performed to identify associations between mFI-5 and demographic, comorbid, and complication variables.

Results

A total of 14,567 patients were identified and stratified by the mFI-5. Univariate analysis showed an increasing incidence of American Society of Anesthesiologists (ASA) class, all comorbidities, and all complications with increasing mFI-5 score (p < 0.001). Multivariable regressions showed increased odds of any surgical complication in patients with mFI-5 ≥ 2 compared with mFI-5 = 0 (aOR 2.56; 95% CI: 1.37–4.76, p = 0.011), as well as increased odds of unplanned readmission (aOR 4.02; 95% CI: 1.16–13.97, p = 0.032) and reoperation (aOR 6.61; 95% CI: 1.07–40.68, p = 0.042).

Conclusion

The mFI-5 is associated with increased incidence of comorbidities and complications, as well as increased odds of surgical complications, unplanned readmission, and reoperation in patients undergoing parotidectomy for malignancy, independent of age and ASA class. The mFI-5 can be utilized in the risk stratification of these patients.