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

Abstract

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

Free Flaps for Skin and Soft Tissue Reconstruction in the Elderly Patient: Indication or Contraindication

“…Other studies have also evaluated frailty as another parameter for a possible perioperative risk stratification. It was found that the determination of frailty indices or scores may be a more helpful indicator for flap reconstruction, e.g., in the head and neck region or in breast reconstruction, than age itself [ 12 , 37 , 38 , 39 ]. Thus, higher frailty scores have been found to be associated with a negative outcome after free flap surgery [ 39 ], and that frail patients benefit from being cared for in the intensive care unit after flap surgery [ 12 , 40 ].…”

Evaluation of modified frailty index for predicting post‐operative outcomes after lower‐extremity free‐flap reconstruction

“…The 5‐mFI score is a valuable prognostic tool for post‐surgical morbidity and mortality that has been adapted for multitude of specialties (Balla et al, 2019; Chimukangara et al, 2017; Lee et al, 2020; Runner et al, 2017; Segal et al, 2018; Traven et al, 2019; Wilson et al, 2018; Yagi et al, 2019). In recent years, this metric has been rapidly drawing attention as a tool for pre‐operative risk stratification and patient counseling and its use has bled into the realm of plastic surgery (Jain et al, 2021; Lee et al, 2020). While previous literature has highlighted the influence of individual risk factors for 30‐day complications after LE free‐flap reconstruction, the use of 5‐mFI as a comprehensive predictive tool in this arena has not been previously described.…”

Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction

“…Recently, the mFI‐5 has been studied for predicting negative outcomes in microsurgical reconstruction (Jain et al, 2021; Mascarella et al, 2022). Jain et al (2021) conducted a retrospective analysis using the NSQIP database, focusing on 11,852 breast cancer patients who underwent free‐flap breast.…”