Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly

Lee, Jasmine; Alfonso, Allyson R.; Kantar, Rami S.; Diep, Gustave K; Berman, Zoe P; Ramly, Elie P.; Daar, David A.; Levine, Jamie P.; Ceradini, Daniel J.

doi:10.1097/gox.0000000000002987

Cited by 25 publications

(28 citation statements)

References 37 publications

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“…Frailty scores are calculated utilizing age-related conditions; immunosuppression in the elderly and their preexisting comorbidities may further predispose them to wound infections (13,45). Elevated frailty scores are known to predispose patients to elevated complication incidence, particularly in the elderly, and are superior predictors relative to age (43,45,46).…”

Section: Discussionmentioning

confidence: 99%

Frailty Is Superior to Age for Predicting Readmission, Prolonged Length of Stay, and Wound Infection in Elective Otology Procedures

et al. 2022

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Objective: To determine the predictive ability of the 5-point modified frailty index relative to age in elective otology patients. Study Design: Retrospective database analysis. Setting: Multicenter, national database of surgical patients. Patients: We selected all elective surgical patients who received tympanoplasty, tympanomastoidectomy, mastoidectomy, revision mastoidectomy, and cochlear implant procedures from 2016 to 2019 from the National Surgical Quality Improvement database. Interventions: Therapeutic. Main Outcome Measures: Readmission rates, discharge disposition, reoperation rates, and extended length of hospital stay. Results: Utilizing receiver operating characteristics with area under the curve (AUC) analysis, nonrobust status was determined to be a superior predictor relative to age of readmission (AUC = 0.628 [p < 0.001] versus AUC = 0.567 [p = 0.047], respectively) and open wound infection relative to age (AUC = 0.636 [p = 0.024] versus AUC = 0.619 [p = 0.048], respectively). Nonrobust otology patients were more likely to have dyspnea at rest and an American Society of Anesthesiology score higher than 2 before surgery (odds ratios, 13.304 [95% confidence interval, 2.947-60.056; p < 0.001] and 7.841 [95% confidence interval, 7.064-8.704; p < 0.001], respectively). Conclusion: Nonrobust status was found to be a useful predictor of readmission and prolonged length of stay in patients undergoing elective otology procedures, which generally have low complication rate. Given the aging population and corresponding increase in otology disease, it is important to use age-independent risk stratification measures. Frailty may provide a useful risk stratification tool to select surgical candidates within the aging population.

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Section: Discussionmentioning

confidence: 99%

Frailty Is Superior to Age for Predicting Readmission, Prolonged Length of Stay, and Wound Infection in Elective Otology Procedures

et al. 2022

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“…However, in the early 2010s, NSQIP downsized the number of preoperative variables collected. In response, the 5-factor modified frailty index was developed, which has been demonstrated to be effective in laparoscopic surgery, oncologic surgery, neurosurgery, orthopedic surgery, and recently in plastic surgery in relation to panniculectomies, among others (Fagenson et al, 2020;Khalafallah et al, 2020;Lee et al, 2020;Saadeddin et al, 2020;Simon et al, 2020;Tracy et al, 2020). Thus, we sought to demonstrate its effectiveness in free flap breast reconstruction, an important and widespread procedure in our field.…”

Section: Discussionmentioning

confidence: 99%

Using the modified frailty index to predict negative outcomes in free‐flap breast reconstruction: A National Surgical Quality Improvement Project‐based study

et al. 2021

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Background: Post-mastectomy free-flap breast reconstruction is becoming increasingly common in the United States. However, predicting which patients may suffer complications remains challenging. We sought to apply the validated modified frailty index (mFI) to free-flap breast reconstruction in breast cancer patients and determine its utility in predicting negative outcomes. Methods:We conducted a retrospective study using National Surgical Quality Improvement Project (NSQIP). All patients who had a CPT code of 19364, indicative of free tissue transfer for breast cancer reconstruction, were included. Data on preoperative characteristics and postoperative outcomes were collected. Patients were separated based on the number of mFI factors present into three categories: 0, 1, and > 2 factors.Preoperative demographics, clinical status, and other comorbidities were also studied.Negative outcomes were compared using multivariate logistic regression.Results: 11,852 patients (mean age 50.9 ± 9.5) were found; 24.2% had complications, comparable to previous literature. mFI is predictive of all types of negative outcomes.22.5% of all patients with 0 mFI, 27.7% of patients with 1 mFI and 34.2% of patients with at least two mFI had a negative outcome. The most common factors contributing to the mFI were history of hypertension (24.8%) and diabetes (6.1%). mFI was found to be an isolated risk factor for negative outcomes, along with steroid use, American Society of Anesthesiology (ASA) classification, body mass index, and immediate, and bilateral operations.Conclusions: This NSQIP-based study for patients undergoing free flap breast reconstruction shows that the mFI holds predictive value regarding negative outcomes. This provides more information to properly counsel patients before free flap breast reconstruction surgery. | INTRODUCTIONBreast cancer is the most common cancer in women in the United States, with over 250,000 cases and 40,000 deaths each year (Momenimovahed & Salehiniya, 2019). After mastectomy, patients with access to a reconstructive surgeon often choose to undergo breast reconstruction because of its significant psychosocial benefits (Wilkin et al., 2000). Though tissue expander-based reconstruction

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“…A score of 2 or greater on the 5-item MFI is indicative of frailty, as established by previous studies across different specialties and operation types. [13][14][15] Understanding the association of frailty and appendectomy outcomes will allow providers to make more informed decisions on treatment modality (eg, operative vs non-operative) and identify potentially modifiable perioperative risk factors that could be optimized via prehabilitation prior to interval appendectomy in select populations, in order to improve outcomes. Thus, the overarching goal of this study is to assess the association of frailty, as measured by the 5-item MFI, on postoperative outcomes (30-day mortality, 30-day serious complications, 30-day readmissions, and discharge to facility) for older adults undergoing appendectomy.…”

Section: Introductionmentioning

confidence: 99%

The Association of Frailty With Outcomes for Older Adults Undergoing Appendectomy

Salzman

Saliba

et al. 2022

The American Surgeon

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Background Frailty is a potential modifiable predictor of surgical outcomes in older adults. The impact of frailty following appendectomy, a common urgent operation, is unknown for older adults. The study aim was to assess if frailty is associated with worse perioperative outcomes after appendectomy in older adults. Methods We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2016 to 2018 and identified patients 65 and older who underwent appendectomy for acute appendicitis. We identified frailty as a Modified Frailty Index (MFI) score ≥2. Multivariate logistic regression was used to assess the association of frailty with 30-day mortality, serious complications, readmission, and discharge to facility. Results Five thousand seven hundred twenty-eight older adults underwent appendectomy, of which 29.1% were 75 or older, 53.3% female, 74.9% non-Hispanic White, and 17.1% frail. Frail patients experienced worse outcomes: mortality (frail: 1.0% vs non-frail: .3%, P = .001), serious complications (14.2% vs 8.0%, P = <.0001), and discharge to facility (9.3% vs 2.3%, P < .0001). On multivariate logistic regression, frailty was associated with increased mortality (odds ratio [OR] 3.34; 95% confidence interval [CI] 1.28-8.66), serious complications (OR 1.51; 95% CI: 1.17-1.93), and discharge to facility (OR 2.80; 95% CI: 2.00-3.93). Frailty was not significantly associated with readmission ( P = .180). Conclusions Frailty is associated with worse postoperative outcomes following appendectomy in older adults. As frailty is potentially modifiable, it should be routinely assessed and utilized in perioperative optimization and counseling, especially with respect to patient-centered outcomes.

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Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly

Cited by 25 publications

References 37 publications

Frailty Is Superior to Age for Predicting Readmission, Prolonged Length of Stay, and Wound Infection in Elective Otology Procedures

Frailty Is Superior to Age for Predicting Readmission, Prolonged Length of Stay, and Wound Infection in Elective Otology Procedures

Using the modified frailty index to predict negative outcomes in free‐flap breast reconstruction: A National Surgical Quality Improvement Project‐based study

The Association of Frailty With Outcomes for Older Adults Undergoing Appendectomy

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