by Magno-Pardon, David A.; Luo, Jessica; Carter, Gentry C.;
Agarwal, Jayant P.; Kwok, Alvin C.
Plastic and Reconstructive Surgery: January 2022
- Volume 149 - Issue 1 - p 41-47
Background:
The modified five-item frailty index is a validated and
effective tool for assessing risk in surgical candidates. The authors sought to
compare the predictive ability of the modified five-item frailty index to
established risk factors for complications in free flap breast reconstruction.
Methods:
The 2012 to 2018 American College of Surgeons National
Surgical Quality Improvement Program database was queried for free flap breast
reconstructive procedures. Univariate and multivariate regression analysis
models were used to assess how modified five-item frailty index and factors
commonly used to risk stratify (age, body mass index, American Society of
Anesthesiologists classification, and history of smoking) were associated with
complications.
Results: Of the total 10,550 cases, 24.1 percent experienced
complications. A high modified five-item frailty index score is associated with
a higher overall rate of postoperative complications (p < 0.001). This
significant trend was demonstrated in both surgical (p < 0.001) and medical
(p < 0.001) complications. When controlling for other risk factors commonly
used for risk stratification such as age, body mass index, American Society of
Anesthesiologists classification, and history of smoking, the modified
five-item frailty index was significantly associated with medical (OR, 1.75; 95
percent CI, 1.37 to 2.22; p = 0.001) and any complications (OR, 1.58; 95
percent CI, 1.29 to 1.93; p < 0.001) and had the largest effect size.
Assessing for specific complications, the modified five-item frailty index is
the strongest independent predictor of reoperation (OR, 1.41; 95 percent CI,
1.08 to 1.81; p = 0.009).
Conclusion: The modified five-item frailty index is a useful
predictor of postoperative outcomes in patients undergoing free flap breast
reconstruction when compared to other historically considered risk factors for
surgical complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
