The 5-factor modified frailty index predicts health burden following surgery for pituitary adenomas

Khalafallah, Adham M.; Shah, P.; Huq, Sakibul; Jimenez, Adrian E.; Patel, Palak; London, Nyall R.; Hamrahian, Amir H.; Salvatori, Roberto; Gallia, Gary L.; Rowan, Nicholas R.; Mukherjee, Debraj

doi:10.1007/s11102-020-01069-5

Cited by 42 publications

(33 citation statements)

References 36 publications

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“…Despite this limitation, there have been emerging studies that similarly demonstrate the validity of the mFI as a predictor of postoperative adverse events using institutional patient data. 44,51,52 Second, our database was limited to 30-day outcomes, and thus long-term events were not captured. Third, the surgical/medical complications captured by the ACS-NSQIP database are generalized across all specialties, and thus certain head and neck–specific complications (eg, nerve injury) were not included, although the focus of frailty indices is generally upon larger-scale events (eg, cardiac or pulmonary).…”

Section: Discussionmentioning

confidence: 99%

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

Goshtasbi

Birkenbeuel

Lehrich

et al. 2021

Otolaryngol.--head neck surg.

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Objectives To evaluate the impact of preoperative frailty on short-term outcomes following complex head and neck surgeries (HNSs). Study Design Cross-sectional database analysis. Setting American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Methods The 2005 to 2017 ACS-NSQIP was queried for patients undergoing complex HNS. Five-item modified frailty index (mFI) was calculated based on functional status and history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and chronic hypertension. Results A total of 2786 patients (73.1% male) with a mean age of 62.0 ± 11.6 years were included. Compared to nonfrail patients (41.2%), patients with mFI ≥1 (58.8%) had shorter length of operation ( P = .021), longer length of stay (LOS) ( P < .001), and higher rates of 30-day reoperation ( P = .009), medical complications ( P < .001), discharge to nonhome facility (DNHF) ( P < .001), and mortality ( P = .047). These parameters remained statistically significant when compared across all individual mFI scores (all P < .05). After adjusting for age, sex, race, body mass index, smoking, and American Society of Anesthesiologists score via multivariate logistic regression, patients with mFI ≥1 were significantly more likely to undergo reoperation (odds ratio [OR], 1.39), surgical complications (OR, 1.19), medical complications (OR, 1.55), prolonged LOS (OR, 1.29), and DNHF (OR, 1.56) (all P < .05). Multivariate logistic regression also demonstrated that after adjusting for confounders, compared to patients with mFI = 1, patients with mFI = 2-5 (18.7%) were more likely to undergo shorter operations (OR, 0.74), have medical (OR, 1.46) or any complications (OR, 1.27), and have DNHF (OR, 1.62) (all P < .05). Conclusion The 5-point mFI can independently predict short-term surgical outcomes following complex HNS. This simple and reliable metric can potentially lead to improved preoperative counseling and postoperative planning for complex HNS patients.

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Section: Discussionmentioning

confidence: 99%

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

Goshtasbi

Birkenbeuel

Lehrich

et al. 2021

Otolaryngol.--head neck surg.

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“…Frailty is a state of diminished physiological reserve that limits resolution of homeostasis following a stressor 6 . Surgical oncology literature has shown frailty to be a predictor of morbidity and mortality in sinonasal cancer resections, transsphenoidal pituitary resections, meningioma resections, and intracranial surgery 7–13 . However, a population‐level study of the utility of frailty index in patients undergoing SBS has yet to be completed.…”

Section: Introductionmentioning

confidence: 99%

“…6 Surgical oncology literature has shown frailty to be a predictor of morbidity and mortality in sinonasal cancer resections, transsphenoidal pituitary resections, meningioma resections, and intracranial surgery. [7][8][9][10][11][12][13] However, a population-level study of the utility of frailty index in patients undergoing SBS has yet to be completed. The 5-factor modified-frailty index (mFI-5) is an easily calculated score based on five comorbidities gleaned from a patient's history, which has been validated using American College of Surgeons (ACS) NSQIP data and utilized by various surgical specialties.…”

Section: Introductionmentioning

confidence: 99%

Frailty as a Predictor of Postoperative Complications Following Skull Base Surgery

et al. 2021

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Objective/Hypothesis Frailty has emerged as a powerful risk stratification tool across surgical specialties; however, an analysis of the impact of frailty on outcomes following skull base surgery has not been published. The aim of this study was to assess the validity of the 5‐factor modified frailty index (mFI‐5) as a predictor of perioperative morbidity and mortality in patients undergoing skull base surgery. Methods A mFI‐5 score was calculated for patients undergoing skull base surgeries using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2018. Multivariate logistic regression analysis was used to evaluate the association of increasing frailty with complications in the 30‐day postoperative period, with a subanalysis by operative location. Results A total of 17,912 patients who underwent skull base procedures were identified, with 45.5% of patients having a frailty score of one or greater; 44.9% were male and the mean age was 52.0 (±16.1 SD) years. Multivariable regression analysis revealed frailty to be an independent predictor of overall complications (odds ratio [OR]: 1.325, P < .001), life‐threatening complications (OR: 1.428, P < .001), and mortality (OR: 1.453, P < .001). Higher frailty also correlated with increased length of stay. When procedures were stratified by operative location, frailty correlated significantly with overall complications for middle, posterior, and multiple‐fossae operations but not the anterior fossa. Conclusions Frailty demonstrates a significant and stepwise association with life‐threatening postoperative morbidity, mortality, and length of stay following skull base surgeries. mFI‐5 is an objective and easily calculable measure of preoperative risk, which may facilitate perioperative planning and counseling regarding outcomes prior to surgery. Level of Evidence 3 Laryngoscope, 131:1977–1984, 2021

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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%

“…The mFI-5 has been validated extensively in orthopedic surgery, general surgery, vascular surgery, and neurosurgery as predictors of patient outcomes (Khalafallah et al, 2020;Saadeddin et al, 2020;Simon et al, 2020;Tracy et al, 2020). By taking into account numerous major comorbidities, the mFI-5 provides a composite score that takes into account all-important patient factors that play into risk stratification.…”

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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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The 5-factor modified frailty index predicts health burden following surgery for pituitary adenomas

Cited by 42 publications

References 36 publications

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

Association Between 5‐Item Modified Frailty Index and Short‐term Outcomes in Complex Head and Neck Surgery

Frailty as a Predictor of Postoperative Complications Following Skull Base Surgery

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

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