TY - JOUR
T1 - The effect of frailty on short-term outcomes after head and neck cancer surgery
AU - Nieman, Carrie L.
AU - Pitman, Karen
AU - Tufaro, Anthony P.
AU - Eisele, David W.
AU - Frick, Kevin D.
AU - Gourin, Christine G.
N1 - Publisher Copyright:
© 2017 The American Laryngological, Rhinological and Otological Society, Inc.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/1
Y1 - 2018/1
N2 - 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] = 1.5[1.3–1.8]), Medicaid (OR = 1.5[1.3–1.8]), major procedures (OR = 1.6[1.4–1.8]), flap reconstruction (OR = 1.7[1.3–2.1]), high-volume hospitals (OR = 0.7[0.5–1.0]), discharge to a short-term facility (OR = 4.4[2.9–6.7]), or other facility (OR = 5.4[4.5–6.6]). Frailty was a significant predictor of in-hospital death (OR = 1.6[1.1–2.4]), postoperative surgical complications (OR = 2.0[1.7–2.3]), acute medical complications (OR = 3.9[3.2–4.9]), 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.
AB - 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] = 1.5[1.3–1.8]), Medicaid (OR = 1.5[1.3–1.8]), major procedures (OR = 1.6[1.4–1.8]), flap reconstruction (OR = 1.7[1.3–2.1]), high-volume hospitals (OR = 0.7[0.5–1.0]), discharge to a short-term facility (OR = 4.4[2.9–6.7]), or other facility (OR = 5.4[4.5–6.6]). Frailty was a significant predictor of in-hospital death (OR = 1.6[1.1–2.4]), postoperative surgical complications (OR = 2.0[1.7–2.3]), acute medical complications (OR = 3.9[3.2–4.9]), 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.
KW - Frailty
KW - Nationwide Inpatient Sample
KW - comorbidity
KW - complications
KW - head and neck cancer
KW - mortality
KW - surgery
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U2 - 10.1002/lary.26735
DO - 10.1002/lary.26735
M3 - Article
C2 - 28731497
AN - SCOPUS:85038423409
SN - 0023-852X
VL - 128
SP - 102
EP - 110
JO - Laryngoscope
JF - Laryngoscope
IS - 1
ER -