Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures

Key Points Question Do rates or types of complications after distal radius fractures depend on treatment type? Findings In this secondary analysis of a randomized clinical trial of 304 adults from 24 health systems, the method of treatment participants received was associated with the rate or type of complications. Compared with participants who received internal fixation, participants who received any other treatments experienced complications at significantly higher rates. Meaning Choice of distal radius fracture treatment method in older patients should be specific to individual goals to minimize complication risks and improve outcomes.

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“…A modified Frailty Index, a quick 5-item checklist, can also inform surgeons and patients when deciding about operative treatment. 33 …”

Section: Discussionmentioning

confidence: 99%

Assessment of Distal Radius Fracture Complications Among Adults 60 Years or Older

et al. 2019

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“…The mFI-5 has been shown to be an independent predictor of postoperative complications in several surgical specialties, 11 as well as a multitude of individual surgical procedures. 13 , 14 , 17 – 23 The 5-item mFI is more practical to calculate as opposed to the 11-item mFI and the original 70-item index. 24 , 25 Despite the decrease in input variables, the mFI-5 has been validated to correlate with the 11-item index as an independent predictor of postoperative complications in several surgical specialties.…”

Section: Discussionmentioning

confidence: 99%

“…Each of these factors accounts for 1 point, and the minimum value for the mFI-5 is 0, while the maximum value is 5. mFI-5 score was analyzed as a binary categorical variable to compare groups with a low mFI-5 score of <2 with those with a high mFI-5 score of ≥2. 11 , 13 , 14 Patient preoperative demographics, clinical factors, and medical comorbidities at the time of surgery were analyzed. Primary outcomes of the study included wound complication and overall complication.…”

Section: Methodsmentioning

confidence: 99%

Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly

Lee

Alfonso

Kantar

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Due to the high complication rate of panniculectomies, preoperative risk stratification is imperative. This study aimed to assess the predictive value of the 5-item modified frailty index (mFI-5) for postoperative complications in the elderly following panniculectomy. Methods: A retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database for patients over the age of 65 years who underwent a panniculectomy between 2010 and 2015 was conducted. The mFI-5 score was calculated for each patient based on the presence of diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status, and an mFI-5 score of 2 was used as a cutoff. Multivariate logistic and linear regression analysis was used to determine the validity of the mFI-5 as a predictor of postoperative complications. Results: A total of 575 patients were analyzed. Patients with an mFI-5 score of 2 or more (421; 73.2%) had significantly higher rates of wound complications (19.5% versus 12.8%; P = 0.03), overall complications (33.8% versus 19.5%; P < 0.001), and significantly longer hospital length of stay (3.6±5.0 versus 1.9±3.0; P < 0.001). mFI-5 score of 2 or more was an independent risk factor for wound complications (odds ratio, 1.26; 95% confidence interval, 1.08–2.20; P = 0.04) and overall complications (odds ratio, 1.34; 95% confidence interval, 1.09–2.15; P = 0.02). Conclusions: Frailty, as measured by the mFI-5, holds a predictive value regarding outcomes of wound complications and overall complications in elderly patients after panniculectomy. The mFI-5 score can be used to identify high-risk patients before surgery.

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“…4 This database has now been widely utilized, including in studies of malnutrition and postoperative outcomes in orthopedics. 10,11,22,36,[40][41][42] This database includes both academic and private, voluntarily participating institutions from nearly every state in the United States. This prospectively collected database was used to perform a retrospective cohort study.…”

Section: Data Collection and Included Patientsmentioning

confidence: 99%

Role of Hypoalbuminemia as an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures

et al. 2019

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Background: Malnutrition is known to be negatively associated with outcomes after multiple orthopedic procedures. We hypothesized that admission albumin levels, as a marker for malnutrition, would correlate with postoperative outcomes. The purpose of this study was to investigate this relationship following surgery for ankle fracture. Methods: This is a retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients undergoing operative fixation of an ankle fracture were identified. A total of 6138 patients with albumin available for analysis were identified. Baseline patient information, preoperative serum albumin levels, 30-day postoperative complications, readmission, reoperation, and length of stay data were then collected. Poisson regression with robust error variance was performed to assess the effect of preoperative serum albumin level on postoperative outcomes. Results: The mean albumin level was 3.86 g/dL and 20.3% (1246/6138) of patients with available albumin levels were hypoalbuminemic. Multivariate analysis revealed that an albumin level <3.5 g/dL was an independent risk factor for complications (relative risk [RR], 1.42; 95% confidence interval [CI], 1.13-1.78; P = .002) and readmission (RR, 1.54; 95% CI, 1.13-2.08; P = .006). Additionally, when analyzed as a continuous variable, albumin level was negatively correlated with risk of mortality (RR, 0.37; 95% CI, 0.19-0.72; P = .003). Patients with hypoalbuminemia also had significantly longer lengths of stay (4.5 vs 2.1 days; P < .001). Conclusion: While complication rates after fixation of ankle fractures remain low, hypoalbuminemia was a predictor of postoperative course. Malnutrition, therefore, may help inform the decision between surgical and conservative management of patients with ankle fractures potentially amenable to nonoperative management. Additionally, hypoalbuminemia should trigger heightened awareness and prophylactic therapy where appropriate. Level of Evidence: Level III, comparative study.

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Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures

Cited by 109 publications

References 62 publications

Assessment of Distal Radius Fracture Complications Among Adults 60 Years or Older

Assessment of Distal Radius Fracture Complications Among Adults 60 Years or Older

Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly

Role of Hypoalbuminemia as an Independent Predictor of 30-Day Postoperative Complications Following Surgical Fixation of Ankle Fractures

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