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Modified Frailty Index-5 Predicts Complications After Fibula Free Flap Reconstruction for Head and Neck Cancer
Alexis K. Gursky
1, Hailey P. Wyatt
1, Sergio A. Segrera
1, Anandhini Narayanan
*1, Adam Jacobson
2, Jamie Levine
11Hansjörg Wyss Department of Plastic Surgery, New York University Langone, New York, NY; 2Department of Otolaryngology, New York University Langone, New York, NY
Background: Maxillomandibular reconstruction with fibula free flap carries significant morbidity. Accurate preoperative risk stratification is essential. This study assessed the predictive value of the 5-item modified frailty index (mFI-5) for postoperative complications in head and neck cancer reconstruction.
Methods: A retrospective NSQIP analysis (2013-2023) identified patients with head and neck malignancies undergoing fibula free flap maxillomandibular reconstruction. Demographics, comorbidities, and outcomes were collected. mFI-5 was calculated from diabetes, congestive heart failure, COPD, hypertension, and dependent functional status. Outcomes included overall complications, wound complications, and reoperation. Multivariate logistic regression evaluated the predictive value of mFI-5, adjusting for demographic and clinical covariates.
Results: Over 11 years, 1,139 patients underwent fibula free flap reconstruction. The mFI-5 score distribution was 0 (44.6%), 1 (44.6%), 2 (13.3%), and 3 (1.7%), with an overall complication rate of 49.4%. Multivariate regression demonstrated that higher mFI-5 scores were independently associated with overall complications (OR 1.31, 95% CI 1.07-1.61, p = 0.008). wound complications (OR 1.27, 95% CI 1.00-1.61, p = 0.050), and reoperations (OR 1.31, 95% CI 1.03-1.66, p = 0.027). Outcome-specific analysis revealed that higher mFI-5 scores were associated with increased risk of dehiscence (OR 1.43, 95% CI 1.00-2.03, p = 0.047) and postoperative transfusion (OR 1.56, 95% CI 1.01-2.41, p = 0.044).
Conclusion: Complications occurred in nearly half of patients, highlighting the morbidity of fibula free flap maxillomandibular reconstruction. Higher mFI-5 scores independently predicted complications and reoperations, supporting its use for risk stratification, preoperative optimization, and shared decision-making.
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