The predictive value of modified frailty assessment tool for postoperative complications in elderly patients undergoing flap reconstruction with oral squamous cell carcinoma

doi:10.19438/j.cjoms.2024.04.009

Abstract

Abstract: PURPOSE: To explore the predictive value of modified frailty assessment for postoperative complications in elderly patients undergoing flap reconstruction with oral squamous cell carcinoma. METHODS: Retrospective analysis was performed on elderly patients(>60 years old) who underwent oral squamous cell carcinoma resection with free-flap reconstruction at Shanghai Ninth People's Hospital ,Shanghai Jiao Tong University School of Medicine from January 2014 to December 2022. The patients' perioperative data were collected. According to the 5 modified frailty index(5-mFI), the individuals were grouped into frail (≥2 points) and non-frail(<2 points) group. The occurrence rate of short-term postoperative complication was calculated to determine the association between frailty and complications. Logistic regression analysis was applied to identify which postoperative complications were related to frailty with R 4.0.5 software package. RESULTS: A total of 1 083 patients were included. The rate of postoperative complications was 34.7%（376 cases）. Among the patients, 235 cases (21.7%) were classified as the frail group, while 848 cases (78.3%) were classified as the non-frail group. The frail group had a higher incidence of postoperative complications, longer stays in intensive-care unit and postoperative hospital, compared to the non-frail group, with significant difference(P<0.05). After adjusting for confounding factors including gender, age, smoking, and alcohol consumption, multiple logistic regression analysis revealed that pulmonary complications(OR=4.76, 95%CI: 3.32-6.83, P<0.001), flap complications (OR=2.65, 95%CI: 1.57-4.42, P<0.001), and acute kidney injury(OR=3.31, 95%CI: 1.13-9.66, P<0.05) were strongly correlated with frailty. CONCLUSIONS: The 5-mFI score is significantly correlated with postoperative complications in elderly patients undergoing flap reconstruction surgery for oral squamous cell carcinoma, which provides a convenient and concise assessment tool for clinical work.

Key words: Oral squamous cell carcinoma, Postoperative complications, 5-mFI, Frailty assessment

CLC Number:

R739.8

HUANG Can, LUO Tao, SUN Yu. The predictive value of modified frailty assessment tool for postoperative complications in elderly patients undergoing flap reconstruction with oral squamous cell carcinoma[J]. China Journal of Oral and Maxillofacial Surgery, 2024, 22(4): 373-377.

References

[1] Sathiyasekar AC, Chandrasekar P, Pakash A, et al.Overview of immunology of oral squamous cell carcinoma[J]. J Pharm Bioallied Sci, 2016, 8(Suppl 1): S8-S12.
[2] Yang Y, Zhou M, Zeng X, et al.The burden of oral cancer in China, 1990-2017: an analysis for the Global Burden of Disease, Injuries, and Risk Factors Study 2017[J]. BMC Oral Health, 2021, 21(1): 44.
[3] Wu HY, Yang XD, Yang GY, et al.Preoperative oral carbohydrates in elderly patients undergoing free flap surgery for oral cancer: randomized controlled trial[J]. Int J Oral Maxillofac Surg, 2022, 51(8): 1010-1015.
[4] Li D, Wang C, Wei W, et al.Postoperative complications of free flap reconstruction in moderate-advanced head and neck squamous cell carcinoma: a prospective cohort study based on real-world data[J]. Front Oncol, 2022, 12: 792462.
[5] Fancy T, Huang AT, Kass JI, et al.Complications, mortality, and functional decline in patients 80 years or older undergoing major head and neck ablation and reconstruction[J]. JAMA Otolaryngol Head Neck Surg, 2019, 145(12): 1150-1157.
[6] Dent E, Martin FC, Bergman H, et al.Management of frailty: opportunities, challenges, and future directions[J]. Lancet, 2019, 394(10206): 1376-1386.
[7] Ma HR, Liu J, Li SX, et al.A retrospective study on the relationship between 5 Modified Frailty Index(5-mFI) and postoperative complications of gynecological elderly patients undergoing abdominal surgery[J]. BMC Anesthesiol, 2023, 23(1): 127.
[8] Al-Khamis A, Warner C, Park J, et al.Modified frailty index predicts early outcomes after colorectal surgery: an ACS-NSQIP study[J]. Colorectal Dis, 2019, 21(10): 1192-1205.
[9] Parikh N, Sharma P.Frailty as a prognostic indicator in the radical cystectomy population: a review[J]. Int Urol Nephrol, 2019, 51(8): 1281-1290.
[10] Hewitt J, Long S, Carter B, et al.The prevalence of frailty and its association with clinical outcomes in general surgery: a systematic review and meta-analysis[J]. Age Ageing, 2018, 47(6): 793-800.
[11] Luo J, Carter GC, Agarwal JP, et al.The 5-factor modified frailty index as a predictor of 30-day complications in pressure ulcer repair[J]. J Surg Res, 2021, 265: 21-26.
[12] Wang Y, Zheng Y, Wen Z, et al.Effects of frailty on patients undergoing head and neck cancer surgery with flap reconstruction: a retrospective analysis[J]. BMJ Open, 2022, 12(12): e062047.
[13] Liu F, Chen F, Huang J, et al.Prospective study on factors affecting the prognosis of oral cancer in a Chinese population[J]. Oncotarget, 2017, 8(3): 4352-4359.
[14] Ali B, Choi EE, Barlas V, et al.Modified Frailty Index (mFI) predicts 30-day complications after microsurgical breast reconstruction[J]. J Plast Surg Hand Surg, 2022, 56(4): 229-235.
[15] Xu J, Hu J, Yu P, et al.Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: a retrospective analysis of 331 cases[J]. PLoS One, 2017, 12(11): e0188167.
[16] Shaw LM, Iseli TA, Wiesenfeld D, et al.Postoperative pulmonary complications following major head and neck cancer surgery[J]. Int J Oral Maxillofac Surg, 2021, 50(3): 302-308.
[17] Li SJ, Fan J, Zhou J, et al.Diabetes mellitus and risk of bronchopleural fistula after pulmonary resections: a meta-analysis[J]. Ann Thorac Surg, 2016, 102(1): 328-339.
[18] Fleisher LA, Fleischmann KE, Auerbach AD, et al.2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines[J]. J Am Coll Cardiol, 2014, 64(22): e77-e137.
[19] Tu CH, Hong SF.Preoperative anemia: predictor of free flap reconstruction complications in head and neck cancer[J]. Chin J Physiol, 2023, 66(1): 21-27.
[20] Sharma Y, Avina P, Ross E, et al.The overlap of frailty and malnutrition in older hospitalised patients: an observational study[J]. Asia Pac J Clin Nutr, 2021, 30(3): 457-463.