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

OBJECTIVE: To investigate the relationship between frailty status and surgical outcomes in patients undergoing procedures for cricopharyngeus muscle dysfunction (CPMD). METHODS: 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. RESULTS: 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). CONCLUSION: 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.