Frailty adversely affects outcome following free-flap reconstruction in patients with head and neck cancer.

[INTRODUCTION] Frailty is a multisystem aging-associated syndrome characterised by physiological decline and increased vulnerability to stressors. There will be a need for elderly, and possibly frail patients, to undergo complex and lengthy free-flap reconstruction for large head-and-neck defects. The purpose of this study was to evaluate the impact that frailty has on post-operative complications, functional outcomes, and overall survival in this cohort.

[METHODS] A retrospective case-control study of patients undergoing free-flap reconstruction of head-and-neck defects was carried out between 2021-2023. 159 cases were included. Demographic data were collected for each patient, and comorbidities were recorded, including variables contributing to the 5 mFI frailty index. Disease and treatment characteristics were recorded, along with post-operative complications, return to theatre or intensive care unit (ICU), return to eating, and overall survival.

[RESULTS] The mean age of the cohort was 62.11. Patients were characterised as frail in 25.2% of cases. There was a statistically significant increase in respiratory complications (p=0.038), delirium (p<0.001), return to theatre (p=0.010), return to ICU (p<0.001), and delayed return to eating (p=0.028) in the frail cohort. Multivariate analysis demonstrated an increase in post-operative complications in frail patients, in larynx/hypopharynx malignancies, and in patients with a tracheostomy (p=0.005, 0.039, and 0.043 respectively). Overall survival was negatively influenced by age >65 years (p=0.014) and male sex (p=0.042) on multivariate analysis.

[CONCLUSIONS] Data from this study demonstrated a higher risk of post-operative complications and return to theatre or ICU in patients undergoing free-flap reconstruction of complex head-and-neck defects with higher frailty scores, but were not associated with differences in overall survival.