Impact of Frailty on Surgical Outcomes in Patients Treated for Cricopharyngeus Muscle Dysfunction.

Abstract

To investigate the relationship between frailty status and surgical outcomes in patients undergoing procedures for cricopharyngeus muscle dysfunction (CPMD). Retrospective chart review of all patients who underwent upper esophageal sphincter (UES) interventions at a tertiary dysphagia center. Demographic data, frailty indicators, surgical procedure type, and pre- and postoperative Eating Assessment Tool-10 (EAT-10) scores were collected. Frailty was assessed using the Modified Frailty Index-11 (MFI-11), classifying patients as frail or nonfrail, with primary outcome EAT-10 change. One hundred thirty patients were included (72% female; mean age 73.9 years). Of these, 61.5% had cricopharyngeus (CP) bars and 38.5% had Zenker's diverticulum (ZD). Based on MFI-11, 16.9% were classified as frail and 83.1% as nonfrail. Mean ΔEAT-10 scores were significantly greater in nonfrail patients (16.3, SD = 12.0) compared to frail patients (10.7, SD = 11.0, p = 0.047), indicating better perceived swallowing improvement. Secondary analysis showed nonfrail patients had better outcomes for patients with ZD (ΔEAT-10 22.2 [SD = 9.7], p = 0.159) and with CP bar (ΔEAT-10 12.0 [SD = 11.7], p = 0.358). Frailty is a significant predictor of postoperative swallowing outcomes following UES surgery. Mean improvement was seen among both groups, but nonfrail patients derived greater benefit. Nonetheless, frailty status should not preclude intervention; incorporating frailty assessment into preoperative evaluation may improve patient selection and expectations for outcomes in CPMD management.