We sought to examine frailty among patients undergoing osseous free flap (OFF) mandibular reconstruction and to assess frailty as a predictor of outcomes.
Retrospective chart review of OFF mandibular reconstructions, January 2015–August 2021. A modified frailty index was calculated using preoperative comorbidities and functional status. Outcomes: inpatient Clavien-Dindo (CD) IV critical care, surgical site or medical complications; disposition; discharge with tracheostomy tube; length of stay (LOS); unplanned 30-day readmission. Frailty defined as ≥1 frailty-defining diagnosis.
94 cases identified. Mean age: 64.4 years (SD 8.9). Fifty-three cases (56.4%) had ≥1 frailty-defining diagnosis: specifically, 1 (N=30, 56.6%), 2 (N=17, 32.1%) or 3 (N=6, 11.3%). Mean LOS: 12.7 days (SD 6.2). A minority of patients had any CD IV (N=6, 6.4%) or surgical site complication (N=40, 42.6%). Frailty was not associated with discharge to rehabilitation facility (p=0.326), discharge with tracheostomy tube (p=0.061), LOS (p=0.104), unplanned readmission (p=0.807), CD IV complication (p=0.227) or composite of post-operative complications (p=0.674).
To our knowledge this is the largest series assessing frailty in mandibulectomy with OFF reconstruction. We find a low degree of frailty and no association between frailty and outcomes, suggesting this operation can be safely performed for mildly frail patients.