Role of frailty in otorhinolaryngology and head and neck surgery in a secondary and a tertiary care center: a prospective observational two-cohort study

The proportion of elderly patients undergoing otolaryngology and head and neck surgery (OLHNS) is continuously increasing. The present prospective study evaluated whether frailty in patients ≥ 65 years of age was an important predictor of perioperative complications. An unselected series of 276 elderly patients (67% male; median age: 74 years; Charlson Comorbidity Index (CCI) 2+: 85%) undergoing OLHNS surgery in a 6-month period in 2022 and 2023, respectively, in a secondary and in a tertiary care hospital completed the Groningen Frailty Indicator questionnaire. Primary outcome measure was postoperative complications measured with the Clavien-Dindo classification (CDC), which were analyzed using univariate and multivariate binary logic regression models. 34.7% of the patients were frail. Female gender (Odds ratio [OR] = 2.158; confidence interval [CI] = 1.229 to 3.791; p = 0.007) and the CCI (OR = 1.258; CI = 1.135 to 1.396; p < 0.001) were independent predictors for frailty. 22.8% had CDC complications. Frailty (OR = 1.805; CI = 1.001 to 3.252; p = 0.049) and a CCI 2+ (OR = 4.821; CI = 1.102 to 21.079; p = 0.037) were independent predictors for postoperative CDC complications. The inclusion of a frailty assessment into the pre-operative risk assessment is recommended for all patients ≥ 65 years of age planned for OLHNS.