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Is Frailty Associated With Worse Outcomes After Head and Neck Surgery? A Narrative Review

Abstract

Objective

Frailty has emerged as an important determinant of many health outcomes across various surgical specialties. We examined the published literature reporting on frailty as a predictor of perioperative outcomes in head and neck cancer (HNC) surgery.

Study Design

Narrative review with limited electronic database search and cross‐referencing of included studies.

Methods

PubMed was searched from inception until June 2019 to capture studies evaluating an association between frailty and perioperative outcomes among patients undergoing HNC surgery. Primary outcomes included mortality and morbidity, whereas secondary outcomes included in‐hospital cost, length of stay, readmission, and discharge disposition.

Results

We identified nine series examining frailty as a predictor of outcomes in HNC. The majority of studies (77%) identified patients using a large population‐based database such as the National Surgical Quality Improvement Project or National Inpatient Sample. Frailty measures applied in the HNC surgery literature include the modified frailty index, Groningen Frailty Indicator, and John Hopkins Adjusted Clinical Groups frailty‐defining diagnosis indicator. Most studies demonstrated a significant association between frailty and perioperative outcomes, including mortality, perioperative complications, and Clavien‐Dindo grade IV complications. Furthermore, frailty was associated with greater length of hospital stay, readmission rate, and likelihood of discharge to short‐term or skilled nursing facilities.

Conclusion

The current literature demonstrates the utility of frailty as a predictor of perioperative mortality and morbidity. Further research is needed to develop frailty screening measures in order to risk‐stratify patients and optimize modifiable factors preoperatively. Laryngoscope, 2019