The Modified Five-Item Frailty Index to Predict Hand and Wrist Surgical Repair Postoperative Outcomes: An ACS-NSQIP Analysis of 11 369 Patients

Abstract

Background: Hand and wrist injuries can cause painful, everyday obstacles for patients. Carefully indexing preoperative patient health conditions may better inform surgical care, leading to improved postoperative outcomes. The purpose of the present study is to evaluate if the Modified-Five Item Frailty Index (mFI-5) can accurately predict postoperative complications for hand and wrist surgical repair. Methods: A retrospective review of the American College of Surgeons’ National Surgical Quality Improvement Program database was conducted to investigate patients who underwent hand and wrist surgical repair from January 2013 to December 2019. Patient demographics, comorbidities, surgical logistics, and 30-day readmission due to postoperative complications were extracted. Surgical risk proxies including the mFI-5, age, body mass index (BMI), smoking status within 1 year, the Modified Charlson Comorbidity Index (mCCI), comorbidities, and American Society of Anaesthesiologists Physical Status Classification (ASA class) were calculated. Results: A total of 11 369 patients were included. Thirty-day readmission for total postoperative complications (n = 258) was significantly associated with all surgical risk proxies. However, age, mFI-5 > 2, mCCI > 2, comorbidities > 1, and ASA class 2/3 had the highest statistical significance ( P = <.001). Thirty-day readmission rates for surgical site infections (n = 118) had the highest statistical significance with age, BMI, mFI-5 > 2, and ASA class 2/3 ( P = <.001). A Clavien-Dindo score > 1 (n = 224) had the highest statistical significance with age, mCCI > 2, comorbidity of 1, and an ASA class 3 ( P = <.001). Conclusions: The mFI-5 may have value in predicting 30-day readmission due to postoperative complications after surgical repair of hand and wrist injuries.

Frailty is Superior to Age at Predicting Extended Length of Stay and Immediate Postoperative Complications Following Total Wrist Arthrodesis

“…[11][12][13] Ibelli et al conducted a large database study of 11,369 patients and found that a high frailty score was associated with readmission and surgical site infection following hand and wrist surgeries. 26 While those studies did not specifically examine the effect of frailty on patients undergoing TWA, our results show that frail patients undergoing TWA are at increased risk for extended LOS and postoperative complications. It is important to note some of the patients with extended LOS in our study were likely admitted for reasons unrelated to TWA.…”