Using the Modified Frailty Index to Predict Complications in Breast Reduction: A National Surgical Quality Improvement Program Study of 14,160 Cases

Abstract

Background Breast reduction is a generally well-tolerated procedure with high patient satisfaction and low risk of surgical site infection and other complications. While age, obesity and comorbidities have historically been used as surgical risk proxies, recent literature suggests ‘frailty’ measures, such as the modified 5-item frailty index (mFI-5), may be a superior predictor. Objectives To investigate if mFI-5 can predict the likelihood and magnitude of 30-day complications resulting from breast reductions. Methods A retrospective review was performed using the National Surgical Quality Improvement Program (NSQIP) database of patients who underwent breast reduction without other concurrent procedures, from 2013 to 2019. mFI-5 scores were calculated for each patient, and complication data were gathered. Age, BMI, number of major comorbidities, ASA class, smoking status, diabetes, steroid use and mFI-5 score were compared as predictors of all-cause 30-day complications, 30-day surgical site complications of any kind, length of stay, and aggregate Clavien-Dindo complication severity score. Univariate logistic, linear regressions and multivariate logistic regression analyses were performed to evaluate predictive value. Statistical significance was set at p < 0.05. Results A total of 14,160 patients were analyzed. The overall complication rate was 5.6%. The mFI-5 score significantly predicted overall 30-day complications, surgical site complications, complication severity, overnight stay and likelihood of readmission (all p < 0.0001). Conclusions The mFI-5 is a statistically significant predictor for adverse outcomes in breast reduction surgery. The mFI-5 is a simple and reliable tool that can be efficiently used to conduct a preoperative evaluation of patients requesting breast reductions.

Impact of Sociodemographic and Hospital Factors on Inpatient Bilateral Reduction Mammaplasty: A National Inpatient Sample Analysis

“…23 The age and racial composition of the patient cohort in this study generally reflected characteristics of previous studies that investigated breast reduction in a national scope. 24,25 At least one postoperative complication occurred in 14.5% of patients within the cohort; depending on the length of follow-up and definition of complication, the overall complication rate for reduction mammaplasty has been estimated to range from 6.2% to 32%, indicating consistency with the results of our study. [25][26][27] All outcomes examined in this study were predicted by sociodemographic variables.…”

The Modified Frailty Index Predicts Major Complications in Oncoplastic Reduction Mammoplasty

“…The 5-factor mFI has demonstrated efficacy across multiple specialties [21][22][23][24] ; however, most of the current literature is retrospective and derived from NSQIP data. Within the field of plastic and reconstructive surgery, this tool has further demonstrated utility in breast reconstruction, [25][26][27][28][29][30][31] pressure wound reconstruction, 32 complex abdominal wall reconstruction, 33 reduction mammoplasty, 34 and panniculectomy. 35 The ultimate goal of risk calculators are to identify patients preoperatively that are at higher risk for poor outcomes following surgical intervention, especially in an elective setting.…”

“…The 5-factor mFI has demonstrated efficacy across multiple specialties 21–24 ; however, most of the current literature is retrospective and derived from NSQIP data. Within the field of plastic and reconstructive surgery, this tool has further demonstrated utility in breast reconstruction, 25–31 pressure wound reconstruction, 32 complex abdominal wall reconstruction, 33 reduction mammoplasty, 34 and panniculectomy 35 …”

A simplified frailty index and nomogram to predict the postoperative complications and survival in older patients with upper urinary tract urothelial carcinoma

“…Although these indicators measurement indices represent improvements, their feasibility under the pressure of clinical work remains questionable. Therefore, the original modified frailty index (mFI-11) was modified to generate the mFI-5 by removing some variables, and the ability of mFI-5 to characterize frailty has been demonstrated in many studies (9,(21)(22)(23)(24)(25)(26)(27). Overall, frailty is an independent predictor of adverse outcomes after surgery, particular in older adults.…”