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

Wei-Tee Jia D. Matar Lorenzo Puppi Thomas Schaschinger Tobias Niederegger Iman Ghanad Leonard Knoedler Samuel A. Knoedler D. Orgill H. Kreiker C. Rendenbach M. Heiland G. Hundeshagen A. Panayi

Oct 2026 · Microsurgery · Vol 46 7, pp. e70301 · 0 citations · 43 references

Medicine

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.

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