2025 Poster Presentations
P314: MODIFIED FRAILTY INDEX FOR RISK STRATIFICATION IN PATIENTS UNDERGOING SKULL BASE SURGERY FOR SINONASAL MALIGNANCY
Phiwinhlanhla Ndebele-Ngwenya1; Kamdili Ogbutor1; Samuel R Shing2; Srihari Daggumati, MD2; Pablo Llerena2; Mindy Rabinowitz, MD2; Marc Rosen, MD2; James J Evans, MD2; Gurston G Nyquist, MD2; 1Howard University College Of Medicine; 2Thomas Jefferson University Department of Otolaryngology
Objective: The modified frailty index (mFI-5) is a validated risk stratification tool that has been used to reliably predict frailty, morbidity, and mortality after surgical procedures, including anterior cranial fossa surgery. However, risk stratification for surgery involving skull base resection of sinonasal malignancy [SS1] has not been previously described beyond 30 days following surgery. We aim to characterize post-operative outcomes in patients undergoing anterior skull base resection of sinonasal malignancy utilizing the mFI-5 instrument.
Methods: Data were queried from the TriNetX United States-Collaborative Health Records Network on patients who underwent skull base surgery following a diagnosis of malignant neoplasm of nasal cavity (ICD-10 C30.0) or malignant neoplasm of the accessory sinuses (ICD-10 C31). Patients were categorized into cohorts based on their mFI-5 index score comprising of the following diagnoses: non-dependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Each frailty diagnosis contributed a score of 1, with a maximum score of 5. After propensity-score matching, odds ratios of post-operative outcomes including survival, meningitis, cerebrospinal fluid (CSF) leak, percutaneous endoscopic gastrostomy (PEG) dependence, tracheostomy dependence, pneumonia, infection (including sinusitis), pulmonary embolism, stroke, and visual disturbance were compared across cohorts against the control group (mFI-5 score of 0) at 2 months, 6 months, 1 year and 3 years following surgery.
Results: A total of 8,343 patients[SS2] (2,981 with mFI-5=0; 5,329 with mFI-5=1; 2,485 with mFI-5=2; 730 with mFI-5=3) were included in the final analysis. Higher frailty score was correlated with increasing odds of developing any complication at 2 months post-surgery: 1.68 (p< 0.0001) to 1.921 (p< 0.0001) then 2.552 (p< 0.0001) for mFI-5=1,2,3, respectively.
Higher frailty score was associated with increased odds of mortality 6 months after surgery: 1.331 (p=0.0459), 1.692 (p=0.0006), and 1.835 (p=0.0055) for mFI =1,2,3 respectively. A higher frailty score at 6 months also predicted increased odds of PEG dependence (2.069, 2.167, 2.458), tracheostomy dependence (1.7, 1.848, 2.423), post-surgical infection (1.23, 1.397, 1.455), visual disturbance (1.529, 1.839, 2.219) where (OR mFI-5=1< OR mFI-5=2< OR mFI-5=3).
At 3 years post-surgery, increased frailty predicted increased odds of mortality 1.593 (p< 0.0001), 1.705 (p< 0.0001) and 1.921(p< 0.0001) for mFI =1,2,3 respectively. A higher frailty score predicted increased odds of developing a CSF Leak (1.315, 1.568, 2.053), PEG dependence (1.822, 2.287, 2.494), tracheostomy dependence (1.859, 2.135, 2.841), post-surgical infection (1.238, 1.481, 1.631), pneumonia (3.096, 5.152, 8.681), visual disturbance (1.58, 1.981, 2.582) where (OR mFI-5=1< OR mFI-5=2< OR mFI-5=3).
Conclusion: Greater mFI-5 scores in patients undergoing Skull Base Surgery for Sinonasal Malignancy predicted decreased survival and increased incidence of postoperative infection, CSF leak, PEG dependence, tracheostomy dependence and visual disturbance and pneumonia. In particular, at 3 years, patients with an mFI-5=3 had greater odds of decreased survival, meningitis, CSF leak, PEG dependence, tracheostomy dependence, pneumonia, infection.