• Peter Adams, Tamer Ghanem, Robert Stachler, Francis Hall, Vic Velanovich, and Ilan Rubinfeld.
• Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
• JAMA Otolaryngol Head Neck Surg. 2013 Aug 1;139(8):783-9.

ImportanceThe increasing number of elderly and comorbid patients undergoing surgical procedures raises interest in better identifying patients at increased risk of morbidity and mortality, independent of age. Frailty has been identified as a predictor of surgical complications.ObjectiveTo establish the implications of frailty as a predictor of morbidity and mortality in inpatient otolaryngologic operations.DesignRetrospective review of medical records.SettingNational Surgical Quality Improvement Program (NSQIP) participating hospitals.PatientsNSQIP participant use files were used to identify 6727 inpatients who underwent operations performed by surgeons specializing in otolaryngology between 2005 and 2010. The study sample was 50.3% male and 10.2% African American, with a mean (range) age of 54.7 (16-90) years.Main Outcomes And MeasuresA previously described modified frailty index (mFI) was calculated on the basis of NSQIP variables. The effect of increasing frailty on morbidity and mortality was evaluated using univariate analysis. Multivariate logistic regression was used to compare mFI with age, ASA, and wound classification. RESULTS The mean (range) mFI was 0.07 (0-0.73). As the mFI increased from 0 (no frailty-associated variables) to 0.45 (5 of 11) or higher, mortality risk increased from 0.2% to 11.9%. The risk of Clavien-Dindo grade IV complications increased from 1.2% to 26.2%. The risk of all complications increased from 9.5% to 40.5%. All results were significant at P < .001. In a multivariate logistic regression model to predict mortality or serious complication, mFI became the dominant significant predictor.Conclusions And RelevanceThe mFI is significantly associated with morbidity and mortality in this retrospective survey. Additional study with prospective analysis and external validation is needed. The mFI may provide an improved understanding of preoperative risk, which would facilitate perioperative optimization, risk stratification, and counseling related to outcomes.

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