(A624) Risks Associated with Frailty in Microvascular Free Flap Head and Neck Reconstruction: A Systematic Review

Monday, October 13, 2025

12:00 PM - 1:00 PM EDT

Location: OTO EXPO, Posters

Presenting Author(s)

Anvitha R. Metpally, BS

Medical Student
Virginia Tech Carilion School of Medicine
Roanoke, Virginia, United States

Co-Author(s)

MV

Mitchell T. Victor, MD

Resident Physician
Indiana University School of Medicine
Indianapolis, Indiana, United States
MR

Mirian Ramirez, MLIS

Librarian
Ruth Lilly Medical Library, Indiana University School of Medicine
Indianapolis, Indiana, United States
AM

Avinash V. Mantravadi, MD

Associate Professor of Clinical Otolaryngology - Head and Neck Surgery
Indiana University
Indianapolis, IN, United States
MS

Michael W. Sim, MD

Associate Professor
Indiana University School of Medicine
Zionsville, IN, United States
MM

Michael G. Moore, MD

Professor
Indiana University Health
Indianapolis, Indiana, United States
JY

Jessica A. Yesensky, MD

Indiana University Health, United States

Senior Author(s)

Janice L. Farlow, MD, PhD

Assistant Professor
Indiana University
Indianapolis, IN, United States

Disclosure(s):

Anvitha R. Metpally, BS: No relevant relationships to disclose.

Mitchell T. Victor, MD: No relevant relationships to disclose.

Mirian Ramirez, MLIS: No relevant relationships to disclose.

Michael G. Moore, MD: No relevant relationships to disclose.

Janice L. Farlow, MD, PhD: No relevant relationships to disclose.

Introduction: Frailty, characterized by physiologic decline and susceptibility to adverse outcomes, is often a concern in head and neck cancer (HNC) patients undergoing free flap reconstruction (FFR). This systematic review examines the impact of frailty on surgical and functional outcomes in this population.

Methods: Following PRISMA guidelines, two independent reviewers performed a systematic review of MEDLINE, Embase, World of Science, and Cochrane databases from inception to January 13, 2025. Peer-reviewed primary literature excluding case reports that assessed outcomes in patients with HNC undergoing FFR with a validated frailty index were included for analysis. Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS). Data pertaining to surgical and medical complications, hospital course, and functional outcomes were extracted and synthesized.

Results: Twelve studies were included for review, 7 of which were from the US. Nine were of “Good” quality per the NOS. Utilized frailty measures included the 5-item Modified Frailty Index (5-mFI), 11-mFI, Geriatric 8, and Risk Assessment Index. Frailty was consistently associated with poorer swallow function and disposition. Frailty was associated with increased medical complications and length of stay in 7 of 8 and 5 of 7 studies, respectively. Of 5 studies, none demonstrated an association between frailty and mortality. Addition of nutritional (AUC: 0.8 vs 0.65, p<.001) and muscular (AUC: 0.67 vs 0.56, p=.05) indices outperformed frailty alone in predicting postoperative complications.

Conclusions: Existing frailty tools may be useful in predicting disposition and function following FFR. Incorporation of nutritional status and skeletal muscle may improve prognostic performance compared to frailty alone but may limit clinical implementation.