title: A frailty index identifies patients at high risk of mortality after tracheostomy.
abstract: OBJECTIVE
  To evaluate the utility of a modified frailty index as an indicator of postoperative mortality in patients undergoing tracheostomy.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care veterans hospital.
  
  
  METHODS
  A chart review was conducted of consecutive tracheostomies performed between April 2007 and September 2012. A modified frailty index consisting of 11 items based on the Revised Minimum Data Set Mortality Rating Index (MMRI-R) was retrospectively applied using the patient's status immediately prior to tracheostomy. The resultant 6-month calculated mortality risk was compared with both the Veterans Health Administration Surgical Quality Improvement Program's (VASQIP) 30-day calculated mortality and actual mortality.
  
  
  RESULTS
  One hundred consecutive tracheostomies were analyzed. No patients were excluded. Sixty-nine patients died within the study period, with 1-, 6-, and 12-month mortality rates of 25%, 43%, and 59%, respectively. The average calculated 6-month mortality risk using the modified frailty index was 40.5% for nonsurvivors compared with 25.4% for survivors (P = .001). Both the VASQIP calculator and modified frailty index differentiated mortality risks between patients without head and neck cancer who survived less than 6 months versus those who survived longer than 6 months (P = .006 and .01). However, neither the VASQIP nor the modified frailty index differentiated mortality risks for head and neck cancer patients who survived less than 6 months versus greater than 6 months (P = .94 and .26).
  
  
  CONCLUSIONS
  A modified frailty index identifies patients without head and neck cancer at high risk of postoperative mortality after tracheostomy.
authors.affiliation: Department of Otolaryngology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Johnson
authors.forename: Travis L
authors.initials: TL
authors.lastname: Bailey
authors.forename: Kendra K
authors.initials: KK
authors.lastname: Schmid
authors.forename: William M
authors.initials: WM
authors.lastname: Lydiatt
authors.forename: Jason M
authors.initials: JM
authors.lastname: Johanning
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000473:pathology / Q000601:surgery; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005500:Follow-Up Studies; D016330:Frail Elderly; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000401:mortality*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods / Q000401:mortality*
keywords: VASQIP; frailty; mortality; risk calculator; tracheostomy