Modified Frailty Index (mFI) predicts 30-day complications after microsurgical breast reconstruction

Abstract

Frailty lacks a universal definition. The modified Frailty Index (mFI) using patient comorbidities can be used to measure frailty. We hypothesized that mFI predicts 30-day complications after microsurgical breast reconstruction. American College of Surgeons' (ACS) National Surgical Quality Improvement Project (NSQIP) was investigated to identify patients undergoing microsurgical breast reconstruction between 2005-2014 using Current Procedure Terminology (CPT) code, 19364. We used mFI as a measure of frailty. The patients were assigned a frailty score based on the number of preoperative comorbid conditions as defined by the mFI. Other risk indices used include age, BMI, wound class, ASA class. Stratification was performed in ascending order for each. The outcome measure was aggregate 30-day complications. Regression analysis was performed followed by Receptor Operating Characteristic (ROC) curve to determine the accuracy of each risk index in predicting 30-day complications. Of the 3237 patients 24% experienced complications. Univariate logistic regression analysis found odds ratio of complications for frailty score 1 ¼ 22.1 (CI ¼ 17.9-27.3, p < 0.01), and 2 ¼ 28 (CI ¼ 18.3-43, p < 0.01) compared to frailty score ¼ 0. ROC curve demonstrated mFI with the highest concordance score (c-score ¼ 0.816). Multivariable logistic regression found frailty as the strongest independent predictor of 30-day aggregate complications adjusted OR ¼ 22.24, CI ¼ 17.77-27.82, p < 0.01 when compared to other risk indices. The modified Frailty Index is a simple, reliable, and objective tool that can be used to predict postoperative complications after microsurgical breast reconstruction. The application of this tool can help microsurgeons preoperatively identify patients who are at high risk.

A retrospective study on the relationship between 5 modified frailty index (5-mFI) and postoperative complications of gynecological elderly patients undergoing abdominal surgery

“…We also found age (OR 1.08, 95%CI 1.02-1.15; P = 0.009) and operation time (OR 1.01, 95%CI 1.00-1.0; P < 0.001) were also independently associated with complications. This was consistent with the finding by Osaid Alser et al [20] that operation time was an independent predictor of infection complications in 4197 patients who underwent ICF repair, and that Barkat Al et al [21] found an independent predictor of total complications with an age of 30 days in 3237 patients undergoing microsurgical breast reconstruction. However, in 10,550 patients who underwent free flap breast reconstruction, David A. Magno-Pardon [22] et al found that body weight index greater than 30 kg/m 2 (OR 1.45; 95%CI,1.31-1.61 ;p < 0.001) was an independent predictor of complications.…”

Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury

“…8 Frailty, a measure of physiological reserve, broadly defined as the cumulative burden of baseline comorbid conditions and functional status impairment, has been associated with worse postoperative outcomes across surgical subspecialties. [9][10][11][12][13] In recent years, several studies have assessed the impact of baseline frailty status on postoperative outcomes in patients undergoing spine surgery, 14 though its application to spine trauma and TSI has been limited to 2 studies. 15,16 The lack of large scale, high quality, clinical studies on frailty and spine trauma has been emphasized before.…”

Sarcopenia and frailty as predictors of surgical morbidity and oncologic outcomes in retroperitoneal sarcoma

“…[11][12][13] The mFI has been shown to be valuable in identifying at-risk populations and in predicting the risk of morbidity and mortality for various cancerrelated operations. 14,15 Sarcopenia, defined as loss of skeletal muscle mass and function, has also emerged as a relevant predictor of outcomes and risk of complications among cancer patients. [16][17][18] Sarcopenia has been shown to be a predictor of adverse outcomes across multiple surgical and medical fields including gastric cancer, colorectal cancer, and oropharyngeal squamous cell carcinoma.…”

“…The modified frailty index (mFI) is a measure of 11 variables from the American College of Surgeons National Surgical Quality Improvement Project (ACS‐NSQIP) that defines decreased physiologic reserve, or frailty, in surgical patients 11–13 . The mFI has been shown to be valuable in identifying at‐risk populations and in predicting the risk of morbidity and mortality for various cancer‐related operations 14,15 …”