Prognostic value of the 5-Item Modified Frailty Index in elderly patients undergoing free flap reconstruction for head and neck cancer.

Objective

Frailty is a recognized risk factor for poor surgical outcomes, particularly in the elderly. This study evaluates the predictive value of the 5-item Modified Frailty Index in patients aged 70 and older undergoing head and neck cancer resection with microvascular free flap reconstruction. STUDY

Design

Retrospective cohort study.

Setting

Tertiary academic medical center.

Methods

Patients aged ≥ 70 years old who underwent oncologic resection and free flap reconstruction from 2014 to 2022 were included. Patients were stratified by 5-item Modified Frailty Index score into non-frail (0), mildly frail (1), and moderately to severely frail (≥2). Primary outcomes included 90-day mortality, 30-day complications, readmission, and return to the operating room. Multivariable logistic regression was used to control potential confounders.

Results

A total of 211 patients were included. Patients with 5-item Modified Frailty Index scores ≥ 2 had significantly higher 90-day mortality compared to less frail patients (p = 0.031), and they were more frequently discharged to a facility rather than home. While not statistically significant, complication and readmission rates were higher in frail patients. Multivariable analysis showed that patients with 5-item Modified Frailty Index ≥ 2 had increased odds of experiencing complications (OR 2.44, 95 % CI 1.06-5.91)and mortality (OR 1.17, 95 % CI 0.36-4.59).

Conclusion

The 5-item Modified Frailty Index is a simple and clinically useful tool for identifying older head and neck cancer patients at increased risk of adverse outcomes following major surgery. Its incorporation into preoperative risk assessment may improve surgical decision-making and perioperative planning by better stratifying risk and guiding resource allocation.