Comorbidity and Frailty Indices Predict Disposition in Head and Neck Free Flap Patients

Abstract

Objectives: Comorbidity and frailty indices have been used to predict postoperative outcomes, but their reliability in predicting postoperative disposition to nonhome settings after head and neck free flap surgery remains unclear. To evaluate whether indices predict disposition to nonhome settings in patients undergoing head and neck free flap surgery. Methods: Retrospective cohort study of 671 patients who underwent head and neck free flap surgery between September 1, 2014, and September 1, 2024; recurrent cases were excluded. The relationships of frailty indices with postoperative disposition (home vs. nonhome settings), hospital length of stay (LOS), and intensive care unit (ICU) LOS were analyzed. Indices assessed were Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) status, modified frailty index (mFI), and Washington University Head and Neck Comorbidity Index (WUHNCI). Primary outcome was postoperative disposition (discharge to home or nonhome settings). Secondary outcomes included hospital and ICU LOS. Results: Mean age was 64 ± 16 years, with 63% discharged home. Higher index scores were associated with nonhome disposition (p < 0.001), with the CCI showing the strongest predictive performance (AUC = 0.682). Indices were also associated with longer hospital and ICU LOS, while age alone was not predictive. Conclusion: Indices, particularly the CCI, predict discharge disposition and LOS after head and neck free flap surgery. These indices may aid clinicians in counseling patients and families during preoperative planning. Level of Evidence: 3.