A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair

Abstract

Background Frailty is a measure of physiologic reserve associated with increased vulnerability to adverse outcomes following surgery in older adults. The ‘accumulating deficits’ model of frailty has been applied to the NSQIP database, and an 11-item modified frailty index (mFI) has been validated. We developed a condensed 5-item frailty index and used this to assess the relationship between frailty and outcomes in patients undergoing paraesophageal hernia (PEH) repair. Methods The NSQIP database was queried for ICD-9 and CPT codes associated with PEH repair. Subjects ≥60 years who underwent PEH repair between 2011 and 2013 were included. Five of the 11 mFI items present in the NSQIP data on the most consistent basis were selected for the condensed index. Univariate and multivariate logistic regressions were used to determine the validity of the 5-item mFI as a predictor of postoperative mortality, complications, readmission, and non-routine discharge. Results A total of 3711 patients had data for all variables in the 5-item index, while 885 patients had complete data to calculate the 11-item mFI. After controlling for competing risk factors, including age, ASA score, wound classification, surgical approach, and procedure timing (emergent vs non-emergent), we found the 5-item mFI remained predictive of 30-day mortality and patients being discharged to a location other than home (p < 0.05). A weighted Kappa was calculated to assess agreement between the 5-item and 11-item mFI and was found to be 0.8709 (p < 0.001). Conclusions Frailty, as assessed by the 5-item mFI, is a reasonable alternative to the 11-item mFI in patients undergoing PEH repair. Utilization of the 5-item mFI allows for a significantly increased sample size compared to the 11-item mFI. Further study is necessary to determine whether the condensed 5-item mFI is a valid measure to assess frailty for other types of surgery.

Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly

“…The mFI-5 has been shown to be an independent predictor of postoperative complications in several surgical specialties, 11 as well as a multitude of individual surgical procedures. 13 , 14 , 17 – 23 The 5-item mFI is more practical to calculate as opposed to the 11-item mFI and the original 70-item index. 24 , 25 Despite the decrease in input variables, the mFI-5 has been validated to correlate with the 11-item index as an independent predictor of postoperative complications in several surgical specialties.…”

Association of Frailty and Long‐Term Survival in Patients Undergoing Coronary Artery Bypass Grafting

“…Assessments of frailty can be made with clinical scales,22 functional assessments,13, 23 and their combination,24 or by the presence of a constellation of frailty‐defining diagnoses 5, 8, 25. This last method uses the Johns Hopkins Adjusted Clinical Groups (ACG) frailty‐defining diagnoses indicator, which is an instrument based on 10 clusters of frailty‐defining diagnoses (ie, malnutrition, dementia, impaired vision, decubitus ulcer, incontinence of urine, loss of weight, poverty, barriers to access to care, difficulty in walking, and falls; Table S1).…”

Modified frailty index predicts early outcomes after colorectal surgery: an ACS‐NSQIP study

“…Recently, an even simpler and less time‐consuming five‐item modified frailty index (5‐mFI) has been developed. The 5‐mFI has been validated and shown to have significant agreement with the 11‐mFI in the context of upper gastrointestinal and multiorgan resections . However, to date, no study has examined its predictability in solely colorectal surgery patients.…”