{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:34:30Z","timestamp":1789590870869,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,4,27]],"date-time":"2017-04-27T00:00:00Z","timestamp":1493251200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Regional and free flap reconstructions of head and neck defects were collected from the 2006\u20102013 American College of Surgeons National Surgical Quality Improvement Program (ACS\u2010NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)\u2010level complications were defined by Clavien\u2010Dindo classification IV and analyzed with multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 266 flap reconstructions (126 regional and 140 free) with 86 (7.2%) Clavien\u2010Dindo classification IV complications. As modified frailty index increased, a moderate correlation was demonstrated for Clavien\u2010Dindo classification IV complications (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.30). Increasing modified frailty index score was correlated on linear regression with free versus regional flaps: Clavien\u2010Dindo classification IV (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.09; 0.60), morbidity (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.04; 0.59), and mortality (R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.07; 0.46), respectively. On multivariable analysis, the modified frailty index was associated with Clavien\u2010Dindo classification IV complications for all flaps (odds ratio [OR] 4.38; 95% confidence interval [CI] 1.33\u201014.48) and free flaps (OR 6.60; 95%CI 1.02\u201042.52), but not regional flaps (OR 9.05; 95%CI 0.60\u2010137.10).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The modified frailty index score is predictive of critical care support in head and neck resections necessitating reconstruction, specifically for free flaps.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.24790","type":"journal-article","created":{"date-parts":[[2017,4,27]],"date-time":"2017-04-27T17:24:32Z","timestamp":1493313872000},"page":"1578-1585","source":"Crossref","is-referenced-by-count":52,"title":["Frailty index: Intensive care unit complications in head and neck oncologic regional and free flap reconstruction"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2083-3523","authenticated-orcid":false,"given":"Nicholas B.","family":"Abt","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanjun","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidharth V.","family":"Puram","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy D.","family":"Richmon","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Varvares","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Massachusetts Eye and Ear Infirmary Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,4,27]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2010.02.002"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.12.023"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2008.01656.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.M146"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/aft160"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1100\/tsw.2001.58"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.050051"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2014.04.018"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2012.09.015"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-015-2815-2"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-014-1532-3"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2014.10.009"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2012.11.059"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2015.01.532"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.3969"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2016.0707"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-8-24"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2015.12.096"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348949410300201"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199711000-00009"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23947"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2010.07.008"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21351"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.10-6-584"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21813"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12656"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2009.09.007"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.03.050"}],"container-title":["Head &amp; 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