The impact of frailty on perioperative outcomes and resource utilization in sinonasal cancer surgery

Alexander N. Goel, Jivianne T. Lee, Jose G. Gurrola, Marilene B. Wang, Jeffrey D. Suh

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Objectives/Hypothesis: Frailty is a measure of decreased physiologic reserve that has been associated with adverse outcomes in older surgical patients. We aimed to measure the association of preoperative frailty with outcomes in patients undergoing sinonasal cancer surgery. Study Design: Retrospective cohort study. Methods: We identified 5,346 patients in the Nationwide Readmissions Database undergoing sinonasal cancer surgery from 2010 to 2014. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator. Multivariate regression was used to analyze the association of frailty with postoperative outcomes. Results: Frailty was present in 7.4% of patients. Frailty was a significant independent predictor of intensive care unit–level complications (odds ratio [OR]: 4.83; 95% confidence interval [CI]: 2.95-7.93; P <.001) and nonhome discharge (OR: 3.07; 95% CI: 1.68-5.60; P <.001). Compared to nonfrail patients, frail patients had threefold longer median length of stay (12 days vs. 4 days; P <.001) and more than twofold higher median hospital costs ($44,408 vs. $18,660; P <.001). Frailty outperformed advanced comorbidity (defined as Charlson-Deyo score ≥3), age ≥80 years, and markers of surgical complexity (e.g., skull base/orbit involvement, flap reconstruction, neck dissection) in predicting serious complications, nonhome discharge, length of stay, and hospital costs. Conclusions: Frailty appears to have a stronger and more consistent association with adverse outcomes and increased resource utilization after sinonasal cancer surgery than age or comorbidity index. This information may be used in surgical risk stratification and can guide strategies to prevent or mitigate adverse events in this high-risk group. Level of Evidence: NA Laryngoscope, 130:290–296, 2020.

Original languageEnglish
Pages (from-to)290-296
Number of pages7
JournalLaryngoscope
Volume130
Issue number2
DOIs
StatePublished - 1 Feb 2020

Keywords

  • Frailty
  • Nationwide Readmissions Database
  • readmissions
  • resource utilization
  • sinonasal cancer

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