Use of a Six-Item Modified Frailty Index to Predict 30-day Adverse Events, Readmission, and Mortality in Older Patients Undergoing Surgical Fixation of Lower Extremity, Pelvic, and Acetabular Fractures

Abstract

Introduction:This is a retrospective study evaluating the use of a new six-item modified frailty index (MF-6) to predict short-term outcomes of patients receiving surgery for lower extremity fractures.Methods:Patients older than 65 years undergoing open reduction and internal fixation for lower extremity, pelvic, and acetabulum fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program. The MF-6 was calculated by assigning one point for each of six common conditions. Multivariable analysis was used to compare patients with an MF-6 of <3 and ≥3. Outcome measures included complications, mortality, readmission, revision surgery, and length of stay. An area under the curve receiver operator analysis was conducted to compare the MF-6 with MF-5, an existing five-item frailty index.Results:Nine thousand four hundred sixty-three patients were included. Patients with an MF-6 of ≥3 were at markedly higher risk of discharge destination other than home (Exp[B] = 2.09), mortality (Exp[B] = 2.48), major adverse events (Exp[B] = 2.16), and readmission (Exp[B] = 1.82). Receiver-operating curve analysis demonstrated an area under the curve of 0.65 for mortality, 0.62 for major adverse events, and 0.62 for discharge destination other than home, all of which outperformed the MF-5.Discussion:The MF-6 was correlated with a 30-day postoperative incidence of infectious complications, readmission, and discharge destination. MF-6 scores can be used to risk-stratify patient populations as shifts to value-based care continue to develop.

Six-Item Modified Frailty Index independently predicts complications following total shoulder arthroplasty

“…A study by Pean et al investigated MF-6 as a predictor for short-term adverse events following lower extremity open reduction and internal fixation and found that a high MF-6 score was associated with higher rates of infectious complications, readmission, and non-home discharge. 12 The results of our study are consistent with those by Pean et al, as we also found MF-6 ≥3 to be associated with UTI, readmission, and non-home discharge. However, while Pean et al found an association between MF-6 and mortality, we did not find an association with mortality following TSA.…”

“… 7 The Modified Frailty Index originally included 11 items that was simplified to 5 items (diabetes mellitus, CHF, COPD or current pneumonia, hypertension requiring medication, and dependent functional status). 12 The modified 5-item frailty index was shown to retain its predictive power for frailty compared to the original 11-item frailty index. 16 Recently an MF-6 has gained popularity, which includes hypoalbuminemia as the sixth item.…”

“…The score cutoff point of 3 was based on a previous study that looked at MF-6 in lower extremity and pelvic fractures. 12 The MF-6 score was calculated using a 6-point system with one point given for each of the following conditions: COPD, CHF, insulin or noninsulin-dependent diabetes, hypertension, dependent functional status, and hypoalbuminemia. Albumin levels less than 3.5 g/dL were categorized as hypoalbuminemia.…”

“… 3 , 6 , 10 One study found that a high MF-6 score was associated with readmission, non-home discharge, and mortality following open reduction and internal fixation of lower extremity, pelvic, and acetabular fractures. 12 …”

Adverse outcomes following pelvic fracture: the critical role of frailty

“…Using the 6-Item Modified Frailty Index (MF-6), Pean et al investigated the impact of frailty on patients with pelvic fractures, as well as other lower extremity fractures, undergoing surgical fixation. Their comprehensive analyses not only underscored the association of frailty with heightened mortality risk, major adverse events, readmission, and non-home discharge, but also with an extended length of stay [ 39 ].…”