Development and validation of the modified index of fragility in head and neck cancer surgery
Abstract Background This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events. Method An observational study was performed using the American College of Surgeons National Surgi...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2023-01-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | https://doi.org/10.1186/s40463-022-00607-4 |
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| author | Koorosh Semsar-Kazerooni Keith Richardson Véronique-Isabelle Forest Alex Mlynarek Michael P. Hier Nader Sadeghi Marco. A. Mascarella |
| author_facet | Koorosh Semsar-Kazerooni Keith Richardson Véronique-Isabelle Forest Alex Mlynarek Michael P. Hier Nader Sadeghi Marco. A. Mascarella |
| author_sort | Koorosh Semsar-Kazerooni |
| collection | DOAJ |
| description | Abstract Background This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events. Method An observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database, from 2006 to 2018. All patients undergoing nonemergency head and neck cancer surgery were included. A seven-item index (mIFG) was developed using variables associated with frailty, cachexia, and sarcopenia, drawn from the literature (weight loss, low body mass index, dyspnea, diabetes, serum albumin, hematocrit, and creatinine). Multivariable logistic regression was used to model the association between mIFG, postoperative adverse events and death. A validation cohort was then used to ascertain the diagnostic accuracy of the mIFG. Results A total of 23,438 cases were included (16,407 in the derivation group and 7031 in the validation group). There was a total of 4273 postoperative major adverse events (AE) and deaths, 1023 postoperative pulmonary complications and 1721 wound complications. Using the derivation cohort, the 7-item mIFG was independently associated with death, major AEs, pulmonary and wound complications, when controlling for significant covariates. The mIFG predicted death and major adverse events using the validation cohort with an accuracy of 0.70 (95% CI: 0.63–0.76) and 0.64 (95% CI: 0.63–0.66), respectively. The mIFG outperformed the modified Frailty index. Conclusion The modified index of fragility is a reliable and easily accessible tool to predict risk of postoperative adverse events and death in patients undergoing head and neck cancer surgery. Graphical Abstract |
| format | Article |
| id | doaj-art-8660ea5f8b294801addfc76f20ed20e1 |
| institution | Kabale University |
| issn | 1916-0216 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-8660ea5f8b294801addfc76f20ed20e12025-02-02T23:08:47ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162023-01-0152111010.1186/s40463-022-00607-4Development and validation of the modified index of fragility in head and neck cancer surgeryKoorosh Semsar-Kazerooni0Keith Richardson1Véronique-Isabelle Forest2Alex Mlynarek3Michael P. Hier4Nader Sadeghi5Marco. A. Mascarella6Faculty of Medicine, McGill UniversityDepartment of Otolaryngology-Head and Neck Surgery, McGill University Health CenterDepartment of Otolaryngology-Head and Neck Surgery, McGill University Health CenterDepartment of Otolaryngology-Head and Neck Surgery, McGill University Health CenterDepartment of Otolaryngology-Head and Neck Surgery, McGill University Health CenterDepartment of Otolaryngology-Head and Neck Surgery, McGill University Health CenterDepartment of Otolaryngology-Head and Neck Surgery, McGill University Health CenterAbstract Background This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events. Method An observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database, from 2006 to 2018. All patients undergoing nonemergency head and neck cancer surgery were included. A seven-item index (mIFG) was developed using variables associated with frailty, cachexia, and sarcopenia, drawn from the literature (weight loss, low body mass index, dyspnea, diabetes, serum albumin, hematocrit, and creatinine). Multivariable logistic regression was used to model the association between mIFG, postoperative adverse events and death. A validation cohort was then used to ascertain the diagnostic accuracy of the mIFG. Results A total of 23,438 cases were included (16,407 in the derivation group and 7031 in the validation group). There was a total of 4273 postoperative major adverse events (AE) and deaths, 1023 postoperative pulmonary complications and 1721 wound complications. Using the derivation cohort, the 7-item mIFG was independently associated with death, major AEs, pulmonary and wound complications, when controlling for significant covariates. The mIFG predicted death and major adverse events using the validation cohort with an accuracy of 0.70 (95% CI: 0.63–0.76) and 0.64 (95% CI: 0.63–0.66), respectively. The mIFG outperformed the modified Frailty index. Conclusion The modified index of fragility is a reliable and easily accessible tool to predict risk of postoperative adverse events and death in patients undergoing head and neck cancer surgery. Graphical Abstracthttps://doi.org/10.1186/s40463-022-00607-4FrailtySarcopeniaCachexiaHead and neck neoplasmsModified index of fragility |
| spellingShingle | Koorosh Semsar-Kazerooni Keith Richardson Véronique-Isabelle Forest Alex Mlynarek Michael P. Hier Nader Sadeghi Marco. A. Mascarella Development and validation of the modified index of fragility in head and neck cancer surgery Journal of Otolaryngology - Head and Neck Surgery Frailty Sarcopenia Cachexia Head and neck neoplasms Modified index of fragility |
| title | Development and validation of the modified index of fragility in head and neck cancer surgery |
| title_full | Development and validation of the modified index of fragility in head and neck cancer surgery |
| title_fullStr | Development and validation of the modified index of fragility in head and neck cancer surgery |
| title_full_unstemmed | Development and validation of the modified index of fragility in head and neck cancer surgery |
| title_short | Development and validation of the modified index of fragility in head and neck cancer surgery |
| title_sort | development and validation of the modified index of fragility in head and neck cancer surgery |
| topic | Frailty Sarcopenia Cachexia Head and neck neoplasms Modified index of fragility |
| url | https://doi.org/10.1186/s40463-022-00607-4 |
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