Dataset Information

Development and validation of the modified index of fragility in head and neck cancer surgery.

ABSTRACT:

Background

This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events.

Method

An observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database, from 2006 to 2018. All patients undergoing nonemergency head and neck cancer surgery were included. A seven-item index (mIFG) was developed using variables associated with frailty, cachexia, and sarcopenia, drawn from the literature (weight loss, low body mass index, dyspnea, diabetes, serum albumin, hematocrit, and creatinine). Multivariable logistic regression was used to model the association between mIFG, postoperative adverse events and death. A validation cohort was then used to ascertain the diagnostic accuracy of the mIFG.

Results

A total of 23,438 cases were included (16,407 in the derivation group and 7031 in the validation group). There was a total of 4273 postoperative major adverse events (AE) and deaths, 1023 postoperative pulmonary complications and 1721 wound complications. Using the derivation cohort, the 7-item mIFG was independently associated with death, major AEs, pulmonary and wound complications, when controlling for significant covariates. The mIFG predicted death and major adverse events using the validation cohort with an accuracy of 0.70 (95% CI: 0.63-0.76) and 0.64 (95% CI: 0.63-0.66), respectively. The mIFG outperformed the modified Frailty index.

Conclusion

The modified index of fragility is a reliable and easily accessible tool to predict risk of postoperative adverse events and death in patients undergoing head and neck cancer surgery.

SUBMITTER: Semsar-Kazerooni K

PROVIDER: S-EPMC9878788 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Publications

Development and validation of the modified index of fragility in head and neck cancer surgery.

Semsar-Kazerooni Koorosh K Richardson Keith K Forest Véronique-Isabelle VI Mlynarek Alex A Hier Michael P MP Sadeghi Nader N Mascarella Marco A MA

Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 20230126 1

<h4>Background</h4>This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events.<h4>Method</h4>An observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database, from 2006 to 2018. All patients undergoing nonemergency head and neck cancer surgery were included. A seven-item index (mIFG) was developed using variab ...[more]

PMID: 36703217

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Project description:ImportancePatients 65 years or older are the most frequent users of operative resources and are also the most vulnerable to postoperative adverse events (AEs). Frailty indices are increasingly being used for preoperative risk stratification within head and neck cancer surgery, but most models lack a multifactorial basis and cannot be directly applied to clinical practice. A practical risk index is needed for clinicians to gauge risk factors preoperatively.ObjectiveTo develop a preoperative risk index of short-term major postoperative AEs for patients undergoing head and neck cancer surgery.DesignCohort analysis of patients from multiple medical centers undergoing inpatient ablative or reconstructive head and neck cancer surgery and registered in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) from 2006 to 2016.ExposuresInpatient ablative or reconstructive head and neck cancer surgery.Main outcomes and measuresSociodemographic, frailty-related, and surgical factors in the derivation cohort were evaluated using simple and multiple logistic regression. Risk factors were subsequently integrated into a preoperative head and neck surgery risk index (HNSRI) and compared with existing models using the validation cohort. A composite variable of major postoperative AEs was used, including death within 30 days of surgery.ResultsA total of 43 968 operations were found using the ACS NSQIP database. Of these, 12 569 cases were excluded as non-head and neck cancer or emergency surgery. Of the included 31 399 operations reviewed, the mean (SD) patient age was 56.9 (15.4) years, and 16 994 of the patients were women (54.1%). A total of 4556 (14.5%) patients had a major postoperative AE, and 209 (0.7%) died. Older age, male sex, smoking, anticoagulation, recent weight loss, functional dependence, free-tissue transfer, tracheotomy, duration of surgery, wound classification, anemia, leukocytosis, and hypoalbuminemia were independently associated with major AEs or death on multiple regression analysis (C statistic, 0.83). The area under the curve of the HNSRI to predict major AEs including death using the validation cohort (n = 15 699) was 0.84 (95% CI, 0.83-0.85) with a sensitivity of 80.1% (95% CI, 79.4%-80.8%) and specificity, 72.3% (95% CI, 70.3%-74.2%). The HNSRI outperformed existing risk models for prediction of AEs: delta C index of the HNSRI to the modified frailty index 11, 0.23 (95% CI, 0.22-0.25); the American Society of Anesthesiologists classification, 0.14 (95% CI, 0.13-0.16); and the ACS risk calculator, 0.02 (95% CI, 0.01-0.03).Conclusions and relevanceThe proposed HNSRI demonstrated a high sensitivity and specificity for major postoperative AEs and death in the studied population. This risk index can be used to counsel patients awaiting head and neck cancer surgery.

Project description:Augmented production and transport of fine sediments resulting from increased human activities are major threats to freshwater ecosystems, including reservoirs and their ecosystem services. To support large scale assessment of the likelihood of soil erosion and reservoir sedimentation, we developed and validated an environmental fragility index (EFI) for the Brazilian neotropical savannah. The EFI was derived from measured geoclimatic controls on sediment production (rainfall, variation of elevation and slope, geology) and anthropogenic pressures (natural cover, road density, distance from roads and urban centers) in 111 catchments upstream of four large hydroelectric reservoirs. We evaluated the effectiveness of the EFI by regressing it against a relative bed stability index (LRBS) that assesses the degree to which stream sites draining into the reservoirs are affected by excess fine sediments. We developed the EFI on 111 of these sites and validated our model on the remaining 37 independent sites. We also compared the effectiveness of the EFI in predicting LRBS with that of a multiple linear regression model (via best-subset procedure) using 7 independent variables. The EFI was significantly correlated with the LRBS, with regression R2 values of 0.32 and 0.40, respectively, in development and validation sites. Although the EFI and multiple regression explained similar amounts of variability (R2 = 0.32 vs 0.36), the EFI had a higher F-ratio (51.6 vs 8.5) and better AICc value (333 vs 338). Because the sites were randomly selected and well-distributed across geoclimatic controlling factors, we were able to calculate spatially-explicit EFI values for all hydrologic units within the study area (~38,500 km2). This model-based inference showed that over 65% of those units had high or extreme fragility. This methodology has great potential for application in the management, recovery, and preservation of hydroelectric reservoirs and streams in tropical river basins.

Dataset Information

Development and validation of the modified index of fragility in head and neck cancer surgery.

Background

Method

Results

Conclusion

Publications

Development and validation of the modified index of fragility in head and neck cancer surgery.

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