The 5-Item Modified Frailty Index Predicts Postoperative Complications After Cochlear Implantation.

OBJECTIVE

Examine the relationship between frailty and postoperative outcomes in cochlear implant (CI) recipients.

STUDY

DESIGN

Retrospective cohort study.

SETTING

Epic Cosmos Database.

SUBJECT POPULATION: A total of 23,550 cochlear implantations between 2015 and 2023.

INTERVENTION: Unilateral or bilateral cochlear implantation.

MAIN OUTCOME MEASURES: Rates of CI explantation, inpatient admission, nonhome discharge, and major complications such as stroke, myocardial infarction, and renal failure.

RESULTS

Of 23,550 cochlear implantations identified, 53.1% were male, and the average age at implantation was 64.1 years (SD 17.3). The average mFI-5 score was 0.66 (SD 0.81), with 53% of patients having an mFI-5 score of 0. Fewer than 1% of cases had postoperative explantation, inpatient admission, or major complications. Frailty, as measured by mFI-5, was a strong predictor for rates of postoperative complications, readmission, and nonhome discharge. For each one-point increase in mFI-5 score, the odds ratio increased by 1.84 for postoperative inpatient admission ( P <0.000001, 95% CI: 1.70-1.98), 1.41 for discharge to nonhome locations ( P <0.001, 95% CI: 1.18-1.67), and 2.15 for major complications ( P <0.000001, 95% CI: 1.95-2.38). This was as high as 6.96, 2.26, and 8.27, respectively, for severely frail patients (mFI-5 ≥ 3). Age was not a strong predictor of any of the outcome measures. Explanation rates were not significantly associated with frailty scores or age.

CONCLUSION

CI remains a generally safe procedure with low overall complication rates. Contrary to prior studies, frailty as measured by the mFI-5 is a strong predictor of postoperative complications and adverse events for patients undergoing CI.