Key result
Preoperative frailty was a significant independent predictor of intensive care unit-level complications (OR 4.83; 95% CI 2.95-7.93; P<0.001) after sinonasal cancer surgery.
Why the study?
Frailty is associated with adverse outcomes in older surgical patients, but its association with outcomes in sinonasal cancer surgery had not been measured.
Does frailty predict adverse perioperative outcomes and resource utilization in patients undergoing sinonasal cancer surgery?
Cohort (n=5,346)
Yes
Does frailty predict adverse perioperative outcomes and resource utilization in patients undergoing sinonasal cancer surgery?
Frailty is a strong independent predictor of adverse outcomes and increased resource utilization after sinonasal cancer surgery, outperforming age and comorbidity indices.
Frailty was associated with adverse outcomes after sinonasal cancer surgery; leaves open whether frailty screening aids risk stratification.
OBJECTIVES/HYPOTHESIS: Frailty is a measure of decreased physiologic reserve that has been associated with adverse outcomes in older surgical patients. We aimed to measure the association of preoperative frailty with outcomes in patients undergoing sinonasal cancer surgery. STUDY DESIGN: Retrospective cohort study. METHODS: We identified 5,346 patients in the Nationwide Readmissions Database undergoing sinonasal cancer surgery from 2010 to 2014. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. Multivariate regression was used to analyze the association of frailty with postoperative outcomes. RESULTS: Frailty was present in 7.4% of patients. Frailty was a significant independent predictor of intensive care unit-level complications (odds ratio [OR]: 4.83; 95% confidence interval [CI]: 2.95-7.93; P < .001) and nonhome discharge (OR: 3.07; 95% CI: 1.68-5.60; P < .001). Compared to nonfrail patients, frail patients had threefold longer median length of stay (12 days vs. 4 days; P < .001) and more than twofold higher median hospital costs ($44,408 vs. $18,660; P < .001). Frailty outperformed advanced comorbidity (defined as Charlson-Deyo score ≥3), age ≥80 years, and markers of surgical complexity (e.g., skull base/orbit involvement, flap reconstruction, neck dissection) in predicting serious complications, nonhome discharge, length of stay, and hospital costs. CONCLUSIONS: Frailty appears to have a stronger and more consistent association with adverse outcomes and increased resource utilization after sinonasal cancer surgery than age or comorbidity index. This information may be used in surgical risk stratification and can guide strategies to prevent or mitigate adverse events in this high-risk group. LEVEL OF EVIDENCE: NA Laryngoscope, 130:290-296, 2020.
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Goel et al. (2019) conducted a cohort in Sinonasal cancer (n=5,346). Frailty vs. Nonfrail patients was evaluated on Intensive care unit-level complications (OR 4.83, 95% CI 2.95-7.93, p=< .001). Preoperative frailty was a significant independent predictor of intensive care unit-level complications (OR 4.83; 95% CI 2.95-7.93; P<0.001) after sinonasal cancer surgery.
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