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Publications

Journal Article Multicenter Study Ppublish

PubMed: 42855949 DOI: 10.1002/micr.70301

Frailty as a Predictor of Outcomes After Fibula Free Flap for Head and Neck Reconstruction: A Multi-Institutional Analysis Using the mFI-5.

Microsurgery 46(7):e70301

Authors: Jia Wei Tee, Dany Matar, Lorenzo Puppi, Thomas Schaschinger, Tobias Niederegger, Iman Ghanad, Leonard Knoedler, Samuel Knoedler, Dennis P Orgill, Henri Kreiker, Carsten Rendenbach, Max Heiland, Gabriel Hundeshagen, Adriana C Panayi

Affiliations

  • Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University Health Network, Toronto, Canada. Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
  • Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, the Johns Hopkins Hospital, Baltimore, Maryland, USA.
  • Medical Faculty, University of Padua, Padua, Italy.
  • Medical Faculty, University of Heidelberg, Heidelberg, Germany.
  • Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
  • Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
  • Department of Cranio-Maxillofacial and Oral Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Abstract

BACKGROUND

Chronological age inadequately reflects physiologic vulnerability in older adults undergoing complex reconstruction. Frailty, quantified by the 5-item Modified Frailty Index (mFI-5), may better stratify perioperative risk in fibula free flap (FFF) reconstruction for head and neck defects, but its impact remains underdefined.

METHODS

A retrospective cohort study of 406 adults undergoing FFF reconstruction (ACS-NSQIP, 2009-2023) evaluated the association between mFI-5 and 30-day postoperative outcomes. Multivariable logistic regression identified independent predictors of medical and surgical complications.

RESULTS

Higher mFI-5 scores were associated with increased medical complications (14.1% mFI-5 = 0 vs. 34.3% mFI-5 = 2; p = 0.02), including pneumonia and myocardial infarction. mFI-5 = 1 (aOR 1.84; 95% CI, 1.01-3.47) and mFI-5 = 2 (aOR 3.45; 95% CI, 1.38-8.57) independently predicted medical complications; mFI-5 = 2 also predicted surgical complications (aOR 2.27; 95% CI, 1.00-5.43).

CONCLUSIONS

Frailty is a stronger predictor of postoperative morbidity than chronological age. Incorporating frailty assessment may enhance risk stratification and perioperative decision-making.

MeSH

Neoplasms, Multiple Chronic Conditions, Free Tissue Flaps, Frailty