Affiliation:
1. Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USA
2. Department of Otolaryngology – Head and Neck Surgery Thomas Jefferson University Hospital Philadelphia Pennsylvania USA
Abstract
ObjectiveThe modified frailty index (mFI‐5) is a National Surgical Quality Improvement Program‐derived 5‐factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI‐5 is a valid predictive measure in the transoral robotic surgery (TORS) population.MethodsRetrospective study utilizing the TriNetX US‐collaborative health records network querying for TORS patients. Cohorts were stratified by mFI‐5 score which uses five ICD‐10 codes: nonindependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching. Outcome measures included survival, infection, pneumonia, tracheostomy dependence, and percutaneous endoscopic gastrostomy dependence. Reported odds ratios were normalized to mFI‐5 = 0.ResultsA total of 9,081 patients were included in the final analysis. Greater mFI‐5 scores predicted decreased survival and increased incidence of postoperative infection and pneumonia. Odds of 5‐year mortality were 1.93 (p = 0.0003) for mFI‐5 = 2 and 1.90 (p = 0.0002) for mFI‐5 = 3. Odds of 2‐year mortality were 1.25 (p = 0.0125) for mFI‐5 = 1, 1.58 (p = 0.0002) for mFI‐5 = 2, and 1.87 (p = 0.003) for mFI‐5 = 3. Odds of postoperative infection were 1.51 (p = 0.02) for mFI‐5 = 2 and 1.78 (p = 0.05) for mFI‐5 = 3. Two‐year odds of developing pneumonia were 1.69 (p = 0.0001) for mFI‐5 = 2 and 2.84 (p < 0.0001) for mFI‐5 = 3. Two‐month odds of pneumonia were 1.50 (p = 0.0259) for mFI‐5 = 2 and 2.55 (p = 0.0037) for mFI‐5 = 3. mFI‐5 = 4 or 5 had too few patients to analyze. Using polynomial regression to model age versus incident 5‐year post‐TORS death (R2 = 0.99), mFI‐5 scores better predicted survival than age alone.ConclusionThis study demonstrates that mFI‐5 predicts mortality, pneumonia, and postoperative infection independently of age.Level of Evidence4 Laryngoscope, 134:4278–4283, 2024