The effect of frailty on short‐term outcomes after head and neck cancer surgery

OBJECTIVE: To determine the relationship between frailty and comorbidity, in-hospital mortality, postoperative complications, length of hospital stay (LOS), and costs in head and neck cancer (HNCA) surgery. STUDY DESIGN: Cross-sectional analysis. METHODS: Discharge data from the Nationwide Inpatient Sample for 159, 301 patients who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 was analyzed using cross-tabulations and multivariate regression modeling. Frailty was defined based on frailty-defining diagnosis clusters from the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. RESULTS: Frailty was identified in 7. 4% of patients and was significantly associated with advanced comorbidity (odds ratio OR = 1. 51. 3-1. 8), Medicaid (OR = 1. 51. 3-1. 8), major procedures (OR = 1. 61. 4-1. 8), flap reconstruction (OR = 1. 71. 3-2. 1), high-volume hospitals (OR = 0. 70. 5-1. 0), discharge to a short-term facility (OR = 4. 42. 9-6. 7), or other facility (OR = 5. 44. 5-6. 6). Frailty was a significant predictor of in-hospital death (OR = 1. 61. 1-2. 4), postoperative surgical complications (OR = 2. 01. 7-2. 3), acute medical complications (OR = 3. 93. 2-4. 9), increased LOS (mean, 4. 9 days), and increased mean incremental costs (11, 839), and was associated with higher odds of surgical complications and increased costs than advanced comorbidity. There was a significant interaction between frailty and comorbidity for acute medical complications and length of hospitalization, with a synergistic effect on the odds of medical complications and LOS in patients with comorbidity who were also frail. CONCLUSION: Frailty is an independent predictor of postoperative morbidity, mortality, LOS, and costs in HNCA surgery patients, and has a synergistic interaction with comorbidity that is associated with an increased likelihood of medical complications and greater LOS in patients with comorbidity who are also frail. LEVEL OF EVIDENCE: 2c. Laryngoscope, 128: 102-110, 2018.