Predicting postoperative complications following mastectomy in the elderly: Evidence for the 5‐factor frailty index

Abstract

Breast cancer remains the most commonly diagnosed cancer in women in the United States. 1 Surgical options include breast conservation surgery or mastectomy, with similar survival rates. 2,3 Patients who undergo mastectomy can subsequently decide to pursue immediate or delayed breast reconstruction. Postoperative complications of these procedures remain a major concern and lead to significant morbidity, including surgical site infection, skin flap necrosis, loss of implant, and need for reoperation. Complications can result in prolonged hospital stays, increased costs, and the delay of adjuvant therapy. 4 It is important to identify risk factors for post-mastectomy complications to provide adequate counseling and mitigate risk.Several predictors of surgical outcomes have been analyzed, including body mass index (BMI), smoking status, age, and medical comorbidities. More recently, the concept of frailty was introduced as a surrogate for physiologic age, with the goal of developing a more accurate predictor. Frailty is defined as a generalized, aging-related clinical state in which there is a diminished physiological reserve and function and an increased vulnerability to stressors, including surgery. 5 Frailty has been shown to be strongly associated with adverse outcomes, including postoperative complications, mortality,

Frailty is the New Age: A Retrospective Study of Modified Frailty Index for Preoperative Risk Assessment in Autologous Breast Reconstruction

“…27 In a 2021 study by Dammeyer et al, patients with mFI-5 scores of 2 or greater who underwent mastectomies demonstrated higher rates of postoperative complications. 28 This agrees with our findings that incremental increases in preoperative mFI-5 score are associated with a greater likelihood of developing complications postoperatively.…”

Editorial on predicting postoperative complications following mastectomy in the elderly: Evidence for the 5‐factor frailty index

“…It is with great interest that we read the manuscript by Dammeyer et al on the value and reliability of the 5-Factor Fragility Index Score (mFI-5) in predicting 30-day postoperative complications in patients undergoing mastectomies. 1 We commend the authors for using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data base in an ingenious way in order to assess the validity of the mFI-5 for predicting complications after mastectomy. The ACS-NSQIP data base has been used extensively to study the short-term outcomes of mastectomies.…”

The modified 5-item frailty index as a predictor of complications in burn patients

“… 11 This simplified version has been shown to yield consistent predictions of postoperative complications and mortality and has been validated in different cohorts undergoing various surgical procedures. 12 , 13 , 14 Despite this well-documented role of mFI-5 as an accurate risk stratification tool, its applicability and utility for predicting outcomes in patients with severe burns are yet to be determined. Therefore, we aimed to assess the predictive value of mFI-5 for complications and in-hospital mortality in a single-center burn population and to evaluate its potential role in burn-related risk stratification.…”