Frailty Severity and Voice Outcomes After Type 1 Thyroplasty

OBJECTIVE: Frailty is associated with high mortality and morbidity, even for low-risk procedures. The role of frailty in postoperative quality of life is not well characterized. We studied the relationship between frailty and voice outcomes after type 1 thyroplasty. STUDY DESIGN: Retrospective chart review. SETTING: Academic tertiary care voice center. METHODS: Data were collected for type 1 thyroplasties performed 2017 to 2024. Voice was evaluated preoperatively and postoperatively with perceptual voice measures (grade, roughness, breathiness, asthenia, and strain [GRBAS]) and Voice Handicap Index-10 (VHI-10). Frailty was measured using the Modified Frailty Index-5 (MFI-5). Data were compared using analysis of variance. RESULTS: In total, 127 patients underwent surgery (59 female, 47%); 79 were for vocal fold motion impairment (62.2%) and 48 atrophy (37.8%). Mean age was 61.0 (95% confidence interval [CI] 58.5-64.5). In total, 39 had an MFI-5 score of 0 ("robust," 30.7%), 48 MFI-5 = 1 ("pre-frail," 37.8%), and 40 MFI-5 = 2 or more ("frail," 31.4%). Preoperative voice measures were similar across cohorts except for breathiness, which was greater among frail patients (P = .0245). Improvements in perceptual voice outcomes were seen in all groups. The improvement in breathiness was greater among frail patients (-1.4, 95% CI -1.0 to -1.8) compared to pre-frail (-0.8, -0.5 to -1.1) and robust (-0.7, -0.2 to -1.1, P = .0203). Forty-eight patients had preop and postop VHI-10 data. Patients had similar improvement in VHI-10 across levels of frailty (P = .5954). CONCLUSION: Improvements in voice after type 1 thyroplasty were similar across levels of frailty. This was true for both atrophy and unilateral vocal fold immobility.