Role of frailty in otorhinolaryngology and head and neck surgery in a secondary and a tertiary care center: a prospective observational two-cohort study

TL;DR

This study shows that frailty in elderly patients is a key predictor of complications after otolaryngology and head and neck surgery.

Contribution

The study introduces frailty as a significant predictor of postoperative complications in elderly OLHNS patients.

Findings

Frailty was found to be an independent predictor of postoperative complications in patients aged ≥65 undergoing OLHNS.

Female gender and higher Charlson Comorbidity Index scores were also linked to increased frailty risk.

The study recommends including frailty assessment in pre-operative risk evaluations for elderly OLHNS patients.

Abstract

The proportion of elderly patients undergoing otolaryngology and head and neck surgery (OLHNS) is continuously increasing. The present prospective study evaluated whether frailty in patients ≥ 65 years of age was an important predictor of perioperative complications. An unselected series of 276 elderly patients (67% male; median age: 74 years; Charlson Comorbidity Index (CCI) 2+: 85%) undergoing OLHNS surgery in a 6-month period in 2022 and 2023, respectively, in a secondary and in a tertiary care hospital completed the Groningen Frailty Indicator questionnaire. Primary outcome measure was postoperative complications measured with the Clavien-Dindo classification (CDC), which were analyzed using univariate and multivariate binary logic regression models. 34.7% of the patients were frail. Female gender (Odds ratio [OR] = 2.158; confidence interval [CI] = 1.229 to 3.791; p = 0.007) and the CCI (OR = 1.258; CI = 1.135 to 1.396; p < 0.001) were independent predictors for frailty. 22.8% had CDC complications. Frailty (OR = 1.805; CI = 1.001 to 3.252; p = 0.049) and a CCI 2+ (OR = 4.821; CI = 1.102 to 21.079; p = 0.037) were independent predictors for postoperative CDC complications. The inclusion of a frailty assessment into the pre-operative risk assessment is recommended for all patients ≥ 65 years of age planned for OLHNS.

The online version contains supplementary material available at 10.1038/s41598-025-34813-7.

Figures