Comparison Of Modified Frailty Index, Clinical Frailty Scale, ECOG Score and ASA Score in Predicting Postoperative Outcomes Following Head and Neck Cancer Surgery- A Prospective Study

Bhargavan R, Ann Philip F and Jagathnath Krishna KM

Published on: 2022-12-09

Abstract

Introduction: Head and neck cancer (HNC) surgery is considered a serious morbidities and occasional perioperative mortality. There are many scoring systems available for preoperative risk stratifications of HNC patients. There are currently very few prospective studies which assess the role of frailty scores in predicting the postoperative complications. This study was conducted to compare the established preoperative risk assessment tools and Eastern Cooperative Oncology Group Performance Scale (ECOG) and American Society of Anesthesiologists Physical Status (ASA) with frailty scores such as Modified Frailty Index (MFI) and Clinical Frailty Scale (CFS).

Patients and Methods: This is a prospective observational study of all adult HNC patients who underwent endo-surgery in a tertiary cancer center during the study period of 1 year. Patients were scored as per MFI, CFS, ECOG and ASA scores. All patients were followed up for 30 days immediate postoperatively and their postoperative complications were documented. Univariate and multivariate analyses was performed and a p value of ≤ 0.05 was considered statistically significant.

Results: Of the 1319 patients studied, 7.3% had prolonged hospital stay, 2.8% had 30-day morbidity, 0.5% had readmission and mortality was nil. There was no significant association between MFI, CFS and ASA and prolonged postoperative stay, morbidity and readmission. ECOG showed a significant association only with prolonged hospital stay (p = 0.028).

Conclusion: MFI, CFS and ASA were not significantly associated with postoperative complications. Only ECOG was significant associated with prolonged hospital stay. Newer frailty models including cancer specific indices are required to predict the postoperative complications in HNC patients.

Keywords: Head and Neck Cancer; Eastern Cooperative Oncology Group Performance Scale; American Society of Anesthesiologists Physical Status; Modified Frailty Index; Clinical Frailty Scale; Postoperative Complications