Nicholas B Abt1, Yanjun Xie2, Sidharth V Puram1, Jeremy D Richmon1, Mark A Varvares1. 1. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. 2. Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
BACKGROUND: Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk. METHODS: Regional and free flap reconstructions of head and neck defects were collected from the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)-level complications were defined by Clavien-Dindo classification IV and analyzed with multivariable logistic regression. RESULTS: There were 266 flap reconstructions (126 regional and 140 free) with 86 (7.2%) Clavien-Dindo classification IV complications. As modified frailty index increased, a moderate correlation was demonstrated for Clavien-Dindo classification IV complications (R2 = 0.30). Increasing modified frailty index score was correlated on linear regression with free versus regional flaps: Clavien-Dindo classification IV (R2 = 0.09; 0.60), morbidity (R2 = 0.04; 0.59), and mortality (R2 = 0.07; 0.46), respectively. On multivariable analysis, the modified frailty index was associated with Clavien-Dindo classification IV complications for all flaps (odds ratio [OR] 4.38; 95% confidence interval [CI] 1.33-14.48) and free flaps (OR 6.60; 95%CI 1.02-42.52), but not regional flaps (OR 9.05; 95%CI 0.60-137.10). CONCLUSION: The modified frailty index score is predictive of critical care support in head and neck resections necessitating reconstruction, specifically for free flaps.
BACKGROUND: Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk. METHODS: Regional and free flap reconstructions of head and neck defects were collected from the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)-level complications were defined by Clavien-Dindo classification IV and analyzed with multivariable logistic regression. RESULTS: There were 266 flap reconstructions (126 regional and 140 free) with 86 (7.2%) Clavien-Dindo classification IV complications. As modified frailty index increased, a moderate correlation was demonstrated for Clavien-Dindo classification IV complications (R2 = 0.30). Increasing modified frailty index score was correlated on linear regression with free versus regional flaps: Clavien-Dindo classification IV (R2 = 0.09; 0.60), morbidity (R2 = 0.04; 0.59), and mortality (R2 = 0.07; 0.46), respectively. On multivariable analysis, the modified frailty index was associated with Clavien-Dindo classification IV complications for all flaps (odds ratio [OR] 4.38; 95% confidence interval [CI] 1.33-14.48) and free flaps (OR 6.60; 95%CI 1.02-42.52), but not regional flaps (OR 9.05; 95%CI 0.60-137.10). CONCLUSION: The modified frailty index score is predictive of critical care support in head and neck resections necessitating reconstruction, specifically for free flaps.
Authors: Marco A Mascarella; Nikesh Muthukrishnan; Farhad Maleki; Marie-Jeanne Kergoat; Keith Richardson; Alex Mlynarek; Veronique-Isabelle Forest; Caroline Reinhold; Diego R Martin; Michael Hier; Nader Sadeghi; Reza Forghani Journal: Ann Otol Rhinol Laryngol Date: 2021-08-20 Impact factor: 1.973
Authors: Thomas F Barrett; Angela L Mazul; Katelyn O Stepan; C Burton Wood; Randall C Paniello; Jose P Zevallos; Sean Massa; Ryan S Jackson; Nicole C Schmitt; Joseph Zenga; Stephen Y Kang; Patrik Pipkorn; Jason T Rich; Sidharth V Puram Journal: Oral Oncol Date: 2021-05-12 Impact factor: 5.972