Frailty Index Predicting Postoperative Complications Following Endocrine Surgery Performed by Otolaryngologists and Non-Otolaryngologists

Introduction: Patients with higher frailty indices may have more postoperative complications. We aim to examine the association of a frailty index and outcomes of thyroid/parathyroid surgery by otolaryngologists and non-otolaryngologists.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2005-2018 was utilized. The modified frailty index-5 (mFI-5) was assigned to all patients with a score of 1 through 5 based on comorbidities [diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease] and dependent functional status. Univariate and binary logistic regression was performed to determine independent effects of covariates on post-operative complications while accounting for available confounding variables.

Results: A total of 222,941 patients satisfied the inclusion criteria; 78.3% were female and 64.3% were White. 74.5% of patients underwent endocrine surgery by a non-otolaryngologist (NO) and 25.5% of patients underwent surgery by an otolaryngologist (O). Using the mFI-5, 53.3% had a score of 0, 34.4% a score of 1, 11.5% a score of 2, and 0.8% had a score >3. The mFI-5 score distribution amongst the O and NO cohorts were similar. Univariate analysis showed lower readmission rates in patients with mFI-5 = 1 when operated on by otolaryngologists compared to NO (35.5% vs 42.5%, p = 0.006). On multivariable analysis, an increase in mFI-5 score was associated with a significant increased risk of having a postoperative complication in the NO cohort only. For mFI-5 score = 1 (OR = 2.27, CI [1.31-3.92]), mFI-5 score = 2 (OR = 3.90, CI [1.35-11.3]), and mFI-5 score >3 (OR = 5.44, CI [1.05-28.1]).

Conclusions: Our study demonstrated that while mFI-5 had no significant association with postoperative complications following endocrine surgery by an otolaryngologist, association existed for other surgical specialties. Readmission rates were less in the otolaryngology cohort with patients having mFI-5 = 1 but equivalent for mFI-5 > 1. Further research is needed to determine if frailty indices can predict postoperative outcomes for otolaryngologists.