Frailty as a Predictor of Postoperative Outcomes among Patients with Head and Neck Cancer

2019 ◽  
Vol 160 (4) ◽  
pp. 664-671 ◽  
Author(s):  
Kristen D. Pitts ◽  
Alberto A. Arteaga ◽  
Benjamin P. Stevens ◽  
William C. White ◽  
Dan Su ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Length Of Stay ◽  
Head And Neck ◽  
Neck Cancer ◽  
Perioperative Complications ◽  
Frailty Index ◽  
Perioperative Outcomes ◽  
Modified Frailty Index ◽  
American Society ◽  
American Society Of Anesthesiologists

Objectives To understand measures of frailty among preoperative patients and explain how these can predict perioperative outcomes among patients with head and neck cancer. Study Design Retrospective cross-sectional case series with chart review. Setting Academic tertiary medical center. Subjects and Methods A retrospective review was performed of patients presenting to an academic hospital following a surgical procedure for a head and neck cancer diagnosis. Charts were queried for preoperative medical diagnoses to calculate 2 frailty scores: the American College of Surgeons National Surgical Quality Improvement Program modified frailty index and the Johns Hopkins Adjusted Clinical Groups frailty index. The American Society of Anesthesiologists classification system was also analyzed as a predictor. Primary outcomes were mortality, 30-day readmission, and length of stay. Perioperative complications and discharge disposition were also evaluated. Results A total of 410 charts were queried between January 2014 and December 2017. Mortality was 11%; mean ± SD length of stay was 7.4 ± 5.5 days; and the readmission rate was 17%. The modified frailty index score significantly increased the odds of mortality (odds ratio = 1.475, P = .012) and readmission (odds ratio = 1.472, P = .004), the length of stay (relative risk = 1.136, P = .001), and the number of perioperative complications. The American Society of Anesthesiologists classification was also significantly associated with poor outcomes, including readmission, length of stay, and perioperative complications. The Adjusted Clinical Groups index was not a significant predictor of outcomes in this study population. Conclusions This study demonstrated a significant increase in poor perioperative outcomes and mortality among patients with head and neck cancer and increased frailty, as measured by the modified frailty index.

The American Society of Anesthesiologists' class as a comorbidity index in a cohort of head and neck cancer surgical patients

Head & Neck ◽  
2001 ◽  
Vol 23 (11) ◽  
pp. 985-994 ◽  
Author(s):  
Britt C. Reid ◽  
Anthony J. Alberg ◽  
Ann C. Klassen ◽  
Wayne M. Koch ◽  
Jonathan M. Samet
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Surgical Patients ◽  
Comorbidity Index ◽  
American Society ◽  
American Society Of Anesthesiologists

Quality Indicators: Measurement and Predictors in Head and Neck Cancer Free Flap Patients

2018 ◽  
Vol 158 (2) ◽  
pp. 265-272 ◽  
Author(s):  
Antoine Eskander ◽  
Stephen Y. Kang ◽  
Benjamin Tweel ◽  
Jigar Sitapara ◽  
Matthew Old ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Length Of Stay ◽  
Oral Cavity ◽  
Head And Neck ◽  
Neck Cancer ◽  
Free Flap ◽  
Preoperative Assessment ◽  
Assessment Clinic ◽  
Primary Radiotherapy ◽  
The Impact

Objective To determine the predictors of length of stay (LOS), readmission within 30 days, and unplanned return to the operating room (OR) within 30 days in head and neck free flap patients. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (OSU, 2006-2012) were assessed. Multivariable logistic regression to assess the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results In total, 515 patients were identified, of whom 66% had oral cavity cancers, 33% had recurrent tumors, and 28% underwent primary radiotherapy. Of the patients, 31.5% had a LOS greater than 9 days, predicted by longer operative time, oral cavity and pharyngeal tumor sites, blood transfusion, diabetes mellitus, and any complication. A total of 12.6% of patients were readmitted within 30 days predicted by absent OSU preoperative assessment clinic attendance and any complication, and 14.8% of patients had an unplanned OR return predicted by advanced age. Conclusions When assessing quality metrics, adjustment for the complexity involved in managing patients with head and neck cancer with a high comorbidity index, clean contaminated wounds, and a high degree of primary radiotherapy is important. Patients seen in a preoperative assessment clinic had a lower risk of readmission postoperatively, and this should be recommended for all head and neck free flap patients. Quality improvement projects should focus on predictors and prevention of complications as this was the number one predictor of both increased length of stay and readmission.

Analyzing the effects of depression among patients with head and neck cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18038-e18038
Author(s):  
Muhammad Usman Zafar ◽  
Zahid Tarar ◽  
Ghulam Ghous ◽  
Umer Farooq ◽  
Masood Anwar
Keyword(s):  
Head And Neck Cancer ◽  
Length Of Stay ◽  
Head And Neck ◽  
Neck Cancer ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Prior History ◽  
Lower Odds ◽  
History Of

e18038 Background: Patients with head and neck cancer carry the prospect of facial disfigurement in addition to the effects on speech, smell, sight, and taste. As such they are at a higher risk of acquiring emotional distress. Despite this, depression is underreported in this population. We review the National Inpatient Sample (NIS) to understand the effects of depression in patients admitted with any diagnosis of head and neck cancer. Methods: We designed a retrospective study and utilized NIS data for the year 2018. We identified patients with any history of Head and Neck cancer using their specific ICD-10 codes. We also identified codes for depressive disorders. Primary outcome was effect of depression on comorbidities. Secondary outcome was hospital length of stay. Utilizing STATA MP 16.1 we performed multivariate logistic regression analysis. Various comorbidities including previous history of coronary artery disease, congestive heart failure, stroke, smoking, hyperlipidemia, and chemotherapy were incorporated into the analysis. Results: The study population included 15,689 patients that were 18 years or older. Mean age was 64 years. Only 28% of the population was females. The mean hospital length of stay was approximately 7 days. In this group of patients, 12% had a history of depression. Among the different types of head and neck cancers oropharyngeal cancers had the highest percentage of depression rates (14%). In multivariable analysis, patients with depression had a higher comorbidity index but this result did not reach statistical significance (Odds Ratio (OR) 1.02, p = 0.054, 95% Confidence Intervals (CI) 0.999 – 1.045). Patients had higher odds of having depression if they also had a history of stroke (OR 1.4, 95% CI 1.13 – 1.73), prior history of chemotherapy (OR 1.25, 95% CI 1.09 – 1.43), history of hyperlipidemia (OR 1.31, 95% CI 1.16 – 1.48) or were admitted over the weekend (OR 1.21, 95% CI 1.07 – 1.38). Younger age was associated with lower odds of depression (OR 0.98, 95% CI 0.98 – 0.99). Women had higher odds of having depression (OR 1.68, 95% CI 1.51 – 1.88). When compared with white people, people from the following demographics had lower odds of depression – Black (OR 0.56, 95% CI 0.47 – 0.68), Hispanic (OR 0.64, 95% CI 0.49 – 0.83), Asian (OR 0.26, 95% CI 0.17 – 0.43), and others (OR 0.53, 95% CI 0.35 – 0.79). Hospital length of stay was higher among patients with depression (OR 0.7, 95% CI 0.2 – 1.15). Conclusions: Among patients with head and neck cancer, odds of having depression are higher in the white population, older patients, females and patients with prior history of chemotherapy. Depression is associated with higher hospital length of stay. These findings help understand the effect of depression on this susceptible population and identify at risk patients for appropriate screening.

Modified Frailty Index Predicts Postoperative Outcomes in Patients Undergoing Radical Pelvic Surgery

2020 ◽  
Vol 86 (2) ◽  
pp. 95-103
Author(s):  
Shannon L. Mcchesney ◽  
Daniel J. Canter ◽  
Dominique J. Monlezun ◽  
Heather Green ◽  
David A. Margolin
Keyword(s):  
Radical Cystectomy ◽  
Operating Characteristic ◽  
Frailty Index ◽  
Adverse Outcomes ◽  
Pelvic Surgery ◽  
Characteristic Analysis ◽  
Modified Frailty Index ◽  
American Society ◽  
Prediction Of Complications ◽  
American Society Of Anesthesiologists

Patients undergoing radical pelvic surgery such as proctectomy or radical cystectomy are at risk of experiencing a variety of complications. Frailty renders patients vulnerable to adverse events. We hypothesize that frailty measured preoperatively using a validated scoring system correlates with increased likelihood of experiencing Clavien-Dindo grade IV complications and 30-day mortality and may be used as a predictive model for patients preoperatively. The NSQIP database was queried for patients who underwent proctectomy or radical cystectomy from 2008 to 2012. Pre-operative frailty was calculated using the 11-point modified frailty index (MFI). Patients were scored based on the presence of indicators and categorized into two groups (<3 or ≥3). Major postoperative morbidities and mortality were identified and analyzed in each group. 10,048 proctectomy and cystectomy patients were identified. The MFI was found to be predictive of both 30-day mortality ( P < 0.0001) and Clavien-Dindo grade IV complications ( P < 0.0001). Receiver operating characteristic analysis demonstrated improved discriminative power of the MFI with the addition of American Society of Anesthesiologists class for both prediction of complications and 30-day mortality. An MFI score of ≥3 is predictive of postoperative morbidity and mortality. Providers should be encouraged to calculate frailty preoperatively to predict adverse outcomes.

Frailty Index as a Predictor of Readmission in Patients With Head and Neck Cancer

2021 ◽  
pp. 019459982110434
Author(s):  
Rohith S. Voora ◽  
Alexander S. Qian ◽  
Nikhil V. Kotha ◽  
Edmund M. Qiao ◽  
Minhthy Meineke ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Frailty Index ◽  
Length Of Hospital Stay ◽  
Unplanned Readmission ◽  
Regression Methods ◽  
Icd 10 ◽  
Risk Stratification Tool ◽  
Nationally Representative

Objective To evaluate the predictive utility of the Hospital Frailty Risk Score (HFRS), a stratification tool based on the ICD-10 ( International Classification of Disease, Tenth Revision), and other risk factors for 30-day readmissions and mortality in a nationally representative cohort. Study Design Retrospective database review. Setting Nationwide Readmissions Database (2017). Methods Patients with head and neck cancer who underwent major surgical procedures were identified from the 2017 Nationwide Readmissions Database, representing 116 medical centers nationwide. Bivariate and multivariable logistic regression methods were used to identify factors associated with unplanned 30-day readmission, 30-day readmission mortality, and increased length of hospital stay. Results A total of 14,420 patients underwent major head and neck cancer surgery. Unplanned readmission occurred in 11% of patients. The most common reasons for unplanned readmission were procedural complications (26.5%), sepsis (7.3%), and respiratory failure (3.9%). Elevated frailty index (HFRS ≥5) was identified in 22% of patients. Frailty was associated with higher 30-day readmission rates (18.0% vs 9.5%, P < .01), which held on multivariate modeling (odds ratio [OR], 1.59 [95% CI, 1.37-1.85]). Frail patients spent more days in the hospital (8.2 vs 6.8, P = .02) and incurred more charges across hospital stays ($275,000 vs $188,000, P < .01). Patients >75 years old (OR, 1.26 [1.03-1.55]) and patients with electrolyte abnormalities (OR, 1.25 [1.07-1.46] were significantly more likely to be readmitted. Conclusion In this head and neck cancer surgical population, HFRS significantly predicted unplanned readmission. HFRS is a potential risk stratification tool and should be compared with other methods and explored in other cancer populations. Beyond the challenge of identifying at-risk patients, future work should explore potential interventions aimed at mitigating readmission.

Factors Associated With Head and Neck Cancer Hospitalization Cost and Length of Stay—A National Study

2019 ◽  
Vol 42 (2) ◽  
pp. 172-178 ◽  
Author(s):  
Eric Adjei Boakye ◽  
Kenton J. Johnston ◽  
Thiago A. Moulin ◽  
Paula M. Buchanan ◽  
Leslie Hinyard ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Length Of Stay ◽  
Head And Neck ◽  
Neck Cancer ◽  
National Study ◽  
Factors Associated ◽  
Hospitalization Cost
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