The 5-item Modified Frailty Index is a simple and clinically useful tool for identifying older head and neck cancer patients at increased risk of adverse outcomes following major surgery.
Abstract
Objective
Frailty is a recognized risk factor for poor surgical outcomes, particularly in the elderly. This study evaluates the predictive value of the 5-item Modified Frailty Index in patients aged 70 and older undergoing head and neck cancer resection with microvascular free flap reconstruction.
STUDY
Design
Retrospective cohort study.
Setting
Tertiary academic medical center.
Methods
Patients aged ≥ 70 years old who underwent oncologic resection and free flap reconstruction from 2014 to 2022 were included. Patients were stratified by 5-item Modified Frailty Index score into non-frail (0), mildly frail (1), and moderately to severely frail (≥2). Primary outcomes included 90-day mortality, 30-day complications, readmission, and return to the operating room. Multivariable logistic regression was used to control potential confounders.
Results
A total of 211 patients were included. Patients with 5-item Modified Frailty Index scores ≥ 2 had significantly higher 90-day mortality compared to less frail patients (p = 0.031), and they were more frequently discharged to a facility rather than home. While not statistically significant, complication and readmission rates were higher in frail patients. Multivariable analysis showed that patients with 5-item Modified Frailty Index ≥ 2 had increased odds of experiencing complications (OR 2.44, 95 % CI 1.06-5.91)and mortality (OR 1.17, 95 % CI 0.36-4.59).
Conclusion
The 5-item Modified Frailty Index is a simple and clinically useful tool for identifying older head and neck cancer patients at increased risk of adverse outcomes following major surgery. Its incorporation into preoperative risk assessment may improve surgical decision-making and perioperative planning by better stratifying risk and guiding resource allocation.
Because this retrospective study was limited by sample size, comorbidity-driven mFI-5 scoring, non-standardized delirium screening, and potential residual confounding, mFI-5 should be interpreted as a convenient screening marker rather than a stand-alone predictor.
K. Yamagata, S. Fukuzawa, Shohei Takaoka et al.· Diagnostics· 0 citations
BACKGROUND
Femoral neck fractures (FNFs) are common in the elderly and are typically treated operatively. Tools like frailty assessments may be critical for evaluating peri- and postoperative patient needs. Our study evaluated the utility of frailty, measured by the Risk Analysis Index (RAI) and the Modified 5-Item Frailty Index (mFI-5), in predicting 30-day mortality in patients undergoing hemiarthroplasty (HA) or total hip arthroplasty (THA) for FNFs.
METHODS
A national database was queried from 2015 to 2020 for patients 18 years of age or older undergoing HA or THA for FNFs. A total of 14,913 patients who had surgically managed FNFs were included. The primary outcome was 30-day mortality. Multivariate regressions were used to evaluate predictive value, and receiver operating characteristic curves assessed frailty accuracy.
RESULTS
Frailty as measured by the mFI-5 and RAI was predictive of increased odds of 30-day mortality in HA (RAI = odds ratio (OR): 1.46, 95% confidence interval (CI): 1.31 to 1.64; mFI-5 = OR: 1.10 (1.08 to 1.12, P < 0.001 for both)) and THA (RAI = OR: 1.15 (CI: 1.106 to 1.190, P < 0.001), mFI-5 = OR: 1.50 (CI: 1.167 to 1.923, P = 0.002)). The RAI demonstrated superior risk discrimination when compared to the mFI-5 for THA (RAI = C-statistic: 0.84, 95% CI: 0.45 to 0.83 versus mFI-5 = C-statistic: 0.69, 95% CI: 0.68 to 0.71) and HA (RAI = C-statistic: 0.74, 95% CI: 0.73 to 0.75 versus mFI-5 = C-statistic: 0.62, 95% CI: 0.61 to 0.63).
CONCLUSION
Frailty was found to be a predictor of mortality in patients who had FNFs undergoing THA and HA. Compared to the mFI-5, the RAI demonstrated superior predictive value for mortality across both operations. Thus, the RAI may be a powerful tool for assessing preoperative risk in patients undergoing arthroplasty for FNFs.
Ethan Parisier, Victor Koltenyuk, Nithin K. Gupta et al.· Journal of Arthroplasty· 0 citations
The prognostic value of the 5-factor modified frailty index (mFI-5) in patients with proximal femur fractures who were monitored in the postoperative intensive care unit (ICU) and to evaluate its relationship with clinical outcomes was demonstrated.
Berkay Küçük, Osman Yağız Atlı· Journal of Medicine and Pall...· 0 citations
Introduction: Patients aged 80 years or older undergoing major abdominal
surgery represent a high-risk group with substantial postoperative mortality.
Frailty and reduced physiological reserve are key determinants of adverse
outcomes; however, data focusing specifically on this population are limited.
This study aimed to identify predictors of 30-day mortality, with emphasis on
frailty and physiological reserve.
Materials and Method: This retrospective single-center cohort study
included patients aged 80 years or older who underwent major abdominal
surgery between 2021 and 2025. Frailty was assessed using the five-item
modified frailty index. Physiological reserve was evaluated using preoperative
albumin, hemoglobin, and creatinine levels. The primary outcome was 30-day
mortality. Multivariable logistic regression analysis was performed.
Results: A total of 92 patients were included, with a 30-day mortality rate of
18.5%. Emergency surgery was more frequent among non-survivors (70.6% vs.
12.0%, p<0.001), as was preoperative sepsis (33.3% vs. 4.0%, p=0.003). Severe
frailty was present in 50.0% of non-survivors compared to 14.9% of survivors
(p=0.025). Non-survivors had lower albumin levels (28.4 vs. 37.0 g/L, p=0.001).
In the multivariable analysis, frailty was an independent predictor of mortality
(odds ratio 2.71, 95% confidence interval 1.03–7.16, p=0.044). Albumin showed
a trend toward significance (odds ratio 0.87 per unit increase, p=0.069). The
model demonstrated high discriminative ability (area under the curve 0.899).
Conclusion: Frailty is an independent predictor of 30-day mortality
in patients aged 80 years or older undergoing major abdominal surgery.
Incorporating frailty assessment into routine preoperative evaluation may
improve risk stratification and clinical decision-making.
Keywords: Frailty; Octogenarians; Nonagenarians; Mortality; Surgical
Oncology; General Surgery
M. Şahin, Özge Öztürk, Ş. Sevi̇m et al.· Turkish Journal of Geriatric...· 0 citations
ABSTRACT Background Frailty predicts outcomes after colorectal cancer surgery, but postoperative changes remain unclear. We previously reported improvement in FRAIL Scale‐based frail/pre‐frail status 1 year after curative minimally invasive surgery (MIS). This study examined the components underlying that improvement using the FRAIL Scale and Kihon Checklist (KCL). Methods This secondary analysis included patients aged ≥ 70 years who underwent curative MIS for colorectal cancer and had preoperative and 1‐year postoperative frailty assessments. Changes in FRAIL Scale and KCL indicators were evaluated using paired analyses. Results Among 239 patients assessed preoperatively, 141 were included in the paired analysis. Among FRAIL Scale items, only the weight‐loss criterion improved significantly (35.8% to 9.5%, p < 0.001). In the KCL, oral function risk improved, whereas physical function risk tended to worsen; houseboundness, cognitive decline, and depressive mood were unchanged. Patients whose FRAIL Scale weight‐loss criterion resolved showed a modest 1.2‐kg increase (p = 0.038), whereas mean body weight remained unchanged overall. In sensitivity analyses, the improvement in oral function risk persisted after excluding patients with preoperative bowel obstruction (p = 0.014). After excluding patients receiving oxaliplatin‐containing adjuvant chemotherapy, physical function risk still tended to increase, and fear of falling remained significantly increased (p = 0.011). Conclusions FRAIL Scale improvement was driven mainly by resolution of the weight‐loss criterion, with modest weight gain and no clear overall body‐weight recovery. KCL changes varied across domains and items, with improvement in some aspects but persistence or worsening in others, supporting a multidimensional interpretation of postoperative recovery in older patients.
H. Ushigome, Takuya Suzuki, S. Hayakawa et al.· Annals of Gastroenterologica...· 0 citations
INTRODUCTION
Frailty assessment has proved useful for evaluating the ability to withstand cancer treatments, but it remains understudied in low- and middle-income countries, where the average life expectancy is about two decades lower than in higher-income countries. This study aimed to establish frailty cutoffs to guide treatment decisions by determining optimal G8 (Geriatric 8) and SCOPE-C (SCreening of the Older Person with Cancer) scores to predict postoperative outcomes in older Indian adults with head and neck cancer.
MATERIALS AND METHODS
In a tertiary care cancer facility in North India, patients ≥60 years with primary head and neck cancers undergoing curative surgery were included. This prospective observational study took place from January 2024 to March 2025. Pre-surgical frailty assessment was done by G8 and SCOPE-C. The main outcomes were major surgical complications and 30-day readmission.
RESULTS
Of 115 patients included (mean age 66.9 years; 79.1% male), 22.6% developed major complications and 7.8% required readmission. On multivariable analysis, lower G8 (odds ratio [OR] 0.77, p = 0.007) and flap use (OR 3.21, p = 0.048) predicted major complications, while G8 alone predicted readmissions (OR 0.52, p = 0.001). Receiver operating characteristic analysis identified G8 cutoffs of ≤13 score for predicting complications (area under the curve [AUC] 0.636) and ≤ 11 for readmissions (AUC 0.839). Patients with G8 ≤ 11 had higher readmission rates (17% vs 1.5%; p = 0.003), and G8 ≤ 13 had more major complications (28.8% vs 11.9%; p = 0.04).
DISCUSSION
Compared to the SCOPE-C screening tool, the G8 demonstrated statistically significant predictive value for both major surgical complications and readmissions; however, its low AUC indicates limited sensitivity and guarded clinical usefulness in predicting major postoperative complications.
Amit Kumar, Rajeev Kumar, P. Sagar et al.· Journal of Geriatric Oncolog...· 0 citations
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