The Modified Frailty Index Predicts Outcomes in Immediate Implant-Based Breast Reconstruction

Background Risk stratification is a crucial tool to help in surgical planning and counseling. Historically, this has been measured by age, BMI, smoking status, or medical comorbidities. Frailty, the combined burden of the patient's comorbidities and risk factors, has gained traction as a method of combining disparate risk factors into one number. The modified 5-factor frailty index (mFI-5) is simple to calculate and takes only moments to assign a risk level to a patient. Objectives This study aimed to study the application and efficacy of the mFI-5 as a measurement of operative risk in immediate breast reconstruction. Methods A total of 650 patients undergoing breast reconstruction at our institution were identified. Patients were divided into 5 mFI-5 groups based on their associated comorbidities. Surgical outcomes were compared using the chi(2) or Fisher exact tests for categorical variables and t tests for continuous variables. Results There were 452 patients stratified into the mFI-5 0 group, 155 patients into the mFI-5 1 group, 40 patients into the mFI-5 2 group, and 3 patients into the mFI-5 3 group. There were no patients in our cohort in either the mFI-5 4 or 5 groups. In comparison of the mFI-5 0 group to 1 group, there was a significant difference in postoperative day of infection (32.06 vs. 21.5 days. respectively; P = 0.049). When comparing to the mFI-5 2 group, there was a significant difference in overall complications on univariate analysis (P = 0.012), minor infections on univariate and multivariate analysis (P = 0.050 and P < 0.001), seroma formation on univariate analysis (P = 0.017), hematoma formation (P < 0.001), return to OR (P < 0.001), and replaced implant (P < 0.001) on multivariate analysis. When comparing the mFI-5 1 group to the mFI-5 2 group, there was a significant difference between overall complications on both univariate and multivariate analyses (P = 0.012 and P = 0.041) and minor infections on univariate analysis (P = 0.032). Conclusions The modified 5-factor frailty index is effective in predicting increased complication risks seen after IBR and may be helpful for surgeons when counseling patients and assessing overall operative risk.