Frailty index: Intensive care unit complications in head and neck oncologic regional and free flap reconstruction

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: = 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.