Frailty Severity and Voice Outcomes After Type 1 Thyroplasty
Ari D. Schuman, Alex H. Beck, Louis Abarca, Madeline Brungardt, Julina Ongkasuwan, Adam R. SzymanowskiAbstract
Objective
Frailty is associated with high mortality and morbidity, even for low‐risk procedures. The role of frailty in postoperative quality of life is not well characterized. We studied the relationship between frailty and voice outcomes after type 1 thyroplasty.
Study Design
Retrospective chart review.
Setting
Academic tertiary care voice center.
Methods
Data were collected for type 1 thyroplasties performed 2017 to 2024. Voice was evaluated preoperatively and postoperatively with perceptual voice measures (grade, roughness, breathiness, asthenia, and strain [GRBAS]) and Voice Handicap Index‐10 (VHI‐10). Frailty was measured using the Modified Frailty Index‐5 (MFI‐5). Data were compared using analysis of variance.
Results
In total, 127 patients underwent surgery (59 female, 47%); 79 were for vocal fold motion impairment (62.2%) and 48 atrophy (37.8%). Mean age was 61.0 (95% confidence interval [CI] 58.5‐64.5). In total, 39 had an MFI‐5 score of 0 (“robust,” 30.7%), 48 MFI‐5 = 1 (“pre‐frail,” 37.8%), and 40 MFI‐5 = 2 or more (“frail,” 31.4%). Preoperative voice measures were similar across cohorts except for breathiness, which was greater among frail patients ( P = .0245). Improvements in perceptual voice outcomes were seen in all groups. The improvement in breathiness was greater among frail patients (−1.4, 95% CI −1.0 to −1.8) compared to pre‐frail (−0.8, −0.5 to −1.1) and robust (−0.7, −0.2 to −1.1, P = .0203). Forty‐eight patients had preop and postop VHI‐10 data. Patients had similar improvement in VHI‐10 across levels of frailty ( P = .5954).
Conclusion
Improvements in voice after type 1 thyroplasty were similar across levels of frailty. This was true for both atrophy and unilateral vocal fold immobility.