Preoperative Frailty Screening in Head and Neck Cancer: A Prospective Comparison of Three Assessment Tools.

[BACKGROUND] Whilst guidelines recommend routine frailty screening for elderly patients with head and neck cancer (HNC), no consensus exists on the preferred tool to predict postoperative morbidity. The aim of this study was to assess the predictive capacity of three validated frailty screening tools for postoperative complications in patients undergoing major ablative and reconstructive head and neck surgery.

[METHODS] A prospective cohort of 50 patients aged ≥ 70 years undergoing major ablative and reconstructive HNC surgery was recruited from a single institution in Sydney, Australia. Patients completed three frailty assessment tools pre-operatively: the Clinical Frailty Scale (CFS), Modified Frailty Index-5 (mFI-5) and Modified Frailty Index-11 (mFI-11). Postoperative complications were recorded using the Clavien-Dindo Classification (CDC) and the Comprehensive Complication Index (CCI). Logistic regression and ROC analysis were used to assess predictive performance.

[RESULTS] The CFS increased the odds of severe (CDC ≥ 3) complications five-fold (OR 5.16, 95% CI 1.12, 23.69; AUC 0.70; cut-off 5). Age ≥ 86 years was also a significant predictor of severe complications (OR = 9.00, 95% CI: 1.79, 45.19, p = 0.008, AUC = 0.71), though limited by prevalence. The mFI-5 and mFI-11 demonstrated limited predictive utility for severe complications (AUC = 0.30 and 0.58, respectively).

[CONCLUSION] CFS provided the greatest accuracy in predicting severe complications after free-flap surgery, with high specificity and negative predictive value. Age ≥ 86 years also confers high risk. Incorporating CFS into preoperative pathways may guide surgical decision-making and perioperative interventions to improve patient outcomes.