Preoperative Frailty-Inflammation Phenotypes and Early Functional and Patient-Reported Recovery After Head-and-Neck Oncologic Reconstruction: An Exploratory Prospective Single-Center Cohort Study

Abstract

Background/Objectives: Early recovery after major head-and-neck reconstruction is not determined by flap survival alone. This exploratory study examined whether preoperative frailty-inflammatory phenotypes are associated with delayed swallowing recovery, persistent nutritional dependence, and poorer quality of life at 12 weeks. Methods: In a prospective single-center cohort study, 84 adults undergoing major head-and-neck oncologic reconstruction were assigned to three clinically defined phenotypes: low-risk (n = 28), intermediate (n = 29), and combined frailty-inflammatory (n = 27). Twelve-week outcomes included the Functional Oral Intake Scale (FOIS), MDADI, EORTC global health, PEG dependence, and a composite poor-recovery endpoint. Because of the small sample size, all estimates are reported to two significant figures, and every analysis is regarded as hypothesis-generating. Results: Compared with the low-risk group, the combined phenotype was older (63 ± 9 vs. 55 ± 9 years) and had a higher mFI-5 (3.2 ± 0.6 vs. 1.0 ± 0.7) and CRP/albumin ratio (2.2 ± 0.6 vs. 0.6 ± 0.2; all p < 0.001). At 12 weeks the combined phenotype showed greater weight loss (12 ± 2%), lower FOIS (3.2 ± 1.3), lower MDADI (51 ± 7), and PEG dependence in 52% (all p ≤ 0.002). A higher mFI-5 was associated with poor recovery (adjusted OR 2.1 per point; 95% CI 1.0–4.1; p = 0.04), an estimate whose confidence interval is wide and imprecise. Conclusions: In this small cohort a frailty-inflammatory framework was associated with clinically meaningful heterogeneity in early recovery. The findings are preliminary and require prospective, adequately powered, multicenter validation before any clinical use.