Decision making regarding appropriate treatment for laryngeal cancer is complex. Patients undergoing total laryngectomy experience significant changes in anatomy and physiology and are at risk for significant postoperative complications. These patients represent a group with significant comorbidities. In addition, patients with laryngeal cancer may have alternative management strategies, such as radiotherapy and chemoradiotherapy, available to them. Therefore, identifying patients at increased risk for adverse postsurgical outcomes is especially critical. Modified Frailty Index Score is a simple, objective, and predictive tool, based on 11 variables (diabetes, COPD, hypertension, etc.) which helps in measuring frailty during preoperative assessment. Several studies have validated the mFI as a reliable predictor of postoperative outcomes in vascular, gynecologic oncology, spine and head and neck cancer surgery. Authors studied the utility of this tool in predicting risk for postoperative complications, length of hospitalisation, and discharge disposition for patients undergoing total laryngectomy. They found that mFI score of 3 or higher is associated with increased risk for postoperative complications, longer hospitalisation, and need for post discharge skilled care following total laryngectomy. It can provide a personalised risk assessment to better inform patients, physicians and payers when planning a total laryngectomy. 

Association of modified frailty index score with perioperative risk for patients undergoing total laryngectomy.
Wachal B, Johnson M, Burchell A, et al.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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