The Predictive Value of a Modified Frailty Index on Perioperative Morbidity and Mortality Following Otologic Surgery

Kevin J Quinn; Yuchi Ma; Matthew Carli; Daniel H Coelho

doi:10.1097/ONO.0000000000000029

The Predictive Value of a Modified Frailty Index on Perioperative Morbidity and Mortality Following Otologic Surgery

Otol Neurotol Open. 2023 Mar 9;3(1):e029. doi: 10.1097/ONO.0000000000000029. eCollection 2023 Mar.

Authors

Kevin J Quinn¹, Yuchi Ma¹, Matthew Carli², Daniel H Coelho¹

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
² Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

Abstract

Objectives: Recently, determinants of frailty have become an increasingly recognized perioperative risk stratification tool. This study examines the predictive value of a 5-factor modified frailty index (mFI-5) on perioperative morbidity and mortality in patients undergoing otologic surgery, with a subgroup analysis based on surgery site.

Study design: Cross-sectional analysis.

Setting: National surgical quality improvement program dataset 2005-2019.

Patients: Current procedural terminology (CPT) codes were used to identify patients undergoing all otologic surgeries.

Interventions: Otologic surgeries as indicated by CPT codes, including external ear, middle ear/mastoid, implants, and inner ear/facial nerve subgroups.

Main outcome measures: Primary outcomes examined in this study included rates of overall complications and life-threatening complications within 30 days after surgery. Overall complications included superficial surgical site infections (SSI), deep incisional SSI, readmission, deep vein thrombosis, life-threatening complications, and mortality. Life-threatening complications included those classified as Clavien-Dindo grade IV: cerebrovascular accident, mechanical ventilation for more than 48 hours, reintubation, pulmonary embolism, acute renal failure, cardiac arrest, and myocardial infarction.

Results: A total of 16,859 patients who underwent otologic surgery were identified, resulting in a cohort that was 47.5% male with an average age of 47.6 years (17.1 SD). Multivariable regression analysis of the entire cohort demonstrated a score of 3 or more on the mFI-5 was independently predictive of all postoperative complications (odds ratio (OR): 2.02, P < 0.0001). However, subgroup analysis showed that only "external ear" surgery correlated with mFi-5 (OR 8.03, P = 0.013).

Conclusions: Higher frailty scores as measured by the mFI-5 correlate with postoperative morbidity and mortality after otologic surgery, though subgroup analysis reveals an association only with cases performed on the external ear. These findings suggest that for most otologic surgery, the mFI-5 frailty score is not predictive of postoperative complications.

Keywords: Frailty; NSQIP; Otologic surgery.