Frailty index: Intensive care unit complications in head and neck oncologic regional and free flap reconstruction

Background: Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk. Methods: Regional and free flap reconstructions of head and neck defects were collected from the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)-level complications were defined by Clavien-Dindo classification IV and analyzed with multivariable logistic regression. Results: There were 266 flap reconstructions (126 regional and 140 free) with 86 (7.2%) Clavien-Dindo classification IV complications. As modified frailty index increased, a moderate correlation was demonstrated for Clavien-Dindo classification IV complications (R-2 = 0.30). Increasing modified frailty index score was correlated on linear regression with free versus regional flaps: Clavien-Dindo classification IV (R-2 = 0.09; 0.60), morbidity (R-2 = 0.04; 0.59), and mortality (R-2 = 0.07; 0.46), respectively. On multivariable analysis, the modified frailty index was associated with Clavien-Dindo classification IV complications for all flaps (odds ratio [OR] 4.38; 95% confidence interval [CI] 1.33-14.48) and free flaps (OR 6.60; 95% CI 1.02-42.52), but not regional flaps (OR 9.05; 95% CI 0.60-137.10). Conclusion: The modified frailty index score is predictive of critical care support in head and neck resections necessitating reconstruction, specifically for free flaps.