Frailty, Not Age, May Predict Head–Neck Surgery Outcomes

He added that frailty “is one of those terms that we all understand, but no one can precisely define. Surgeons understand this problem and would certainly benefit from improved metrics to help us understand how to better assist our patients”.

Michael Setzen MD, clinical associate professor of otolaryngology at NYU School of Medicine in New York City and past chair of the board of governors of the American Academy of Otolaryngology-Head and Neck Surgery, offered a more tempered assessment. “I personally do not use this [type of] index when considering the elderly for surgery,” said Dr. Setzen. “I also don’t believe it is used much by others elsewhere in the United States,” so its clinical utility remains to be determined, he told ENTtoday.

A Proven Strategy

Dr. Stachler stressed that his team’s efforts to develop a frailty index are not happening in a vacuum; during his Triological Society annual meeting presentation, he briefly reviewed efforts by several other investigators who are using similar tools for assessing pre-operative risk in broader patient populations. And some of their results are equally striking. In one study of colorectal cancer patients, a comprehensive geriatric risk assessment tool showed that frail patients had at least a two-fold higher risk of developing severe post-operative complications when compared with fit patients (33% versus 62%; P=0.002) (Crit Rev Oncol Hematol. 2010;76:208-217); moreover, in findings similar to those of Dr. Stachler, the authors reported that increasing age and functional status “were not associated with complications.”

In Dr. Stachler’s view, a lot of this is just common sense, albeit confirmed with “a very new, fresh, and exciting” model of risk. “I sometimes see this in my practice, and you certainly hear it all the time: You have an 85-year-old patient who just doesn’t look their age. They still drive a car, they exercise, and their cognition is spot-on. And, because they’ve taken great care of themselves, they don’t have any of the comorbid variables our frailty index weighs so heavily, such as diabetes, hypertension, etc. So biologically, they may be nearer to 60 years of age. Are you really going to deprive them of a surgery that can increase their quality of life even more?”

Armed with a frailty index to assess patients pre-operatively, “such questions won’t even have to come up,” Dr. Stachler said. “It’s a tool that hopefully will remind us of what we should really be looking at in our older patients.”