Frailty is an independent predictor of postoperative rescue medication use after endoscopic sinus surgery.

Abstract

The modified five-item frailty index (mFI-5) is a validated risk stratification tool with the ability to predict adverse outcomes following surgery. In this study, we sought to use mFI-5 to assess the potential relationship between unhealthy aging and postoperative endoscopic sinus surgery (ESS) outcomes. Patients who underwent sinus surgery at Vanderbilt between 2014 and 2018 were identified and assessed using the mFI-5, which iscalculated based on the presence of five comorbidities: diabetes mellitus, hypertension requiring medication, chronic obstructive pulmonary disease, congestive heart failure, and non-independent functional status. Multivariate regression analyses were performed to quantify the association of mFI-5 score on need for rescue oral antibiotics, oral steroids,and antibiotic irrigations within 1 year following ESS, adjusting for relevant potential confounders. Four hundred and three patients met inclusion criteria. Within 6 months of surgery, 312 (77%) required rescue antibiotics, 243 (60%) required oral corticosteroids (OCS), and 31 (8%) initiated antibioticirrigations. Increasing mFI-5 scores were significantly associated with higher postoperative use of rescue antibiotics (p<0.0001), OCS(p=0.032), and antibiotic irrigation (p<0.0001). Frailty scores remained as an independent predictor of these outcomes after adjustment for age, polyp status, preoperative sinonasal outcomes test (SNOT-22) score, and revision surgery status. Modified frailty scores may be a useful clinical tool to predict the need for postoperative rescue medication use after ESS.