The modified 5-item frailty index is a predictor of perioperative risk in breast reconstruction: An analysis of 40,415 cases

Background: The aging population has presented surgeons with new challenges as they increasingly must operate on greater numbers of frail patients. The modified frailty index 5 (mFI-5) is a concise comorbidity-based scale that has been shown to accurately predict adverse surgical outcomes. In this study, we sought to evaluate the ability of the mFI-5 to predict the risk of postoperative outcomes in breast reconstruction patients.Methods: Utilizing the 2015-2019 American College of Surgeons National Surgical Quality Im-provement Program (ACS-NSQIP) database, we identified 40,415 patients who underwent breast reconstruction, of which 29,562 were implant-based reconstructions and 10,853 were autolo-gous breast reconstructions. Demographic and preoperative variables as well as 30-day postop-erative outcomes, including mortality, operation duration, length of hospital stay, medical and surgical complications, and discharge destination, were extracted.Results: Increases in the mFI score correlated with higher rates of reoperation (mFI >3: 13.5% vs. mFI = 0: 5.9%), unplanned readmission (mFI >3: 10.8% vs. mFI = 0: 3.6%), surgical (mFI >3: 12.2% vs. mFI = 0: 4.3%) and medical complications (mFI >3: 6.8% vs. mFI = 0: 1.2%), and lowerrates of home discharge (mFI >= 3: 96% vs. mFI = 0: 99.5%). Multivariate analysis to control for con-founders verified significantly higher rates of reoperation (OR = 0.01, 95%CI 0.005-0.016), un-planned readmission (OR = 0.009, 95%CI 0.005-0.014), and occurrence of surgical complications (OR = 0.014, 95%CI 0.009-0.019) and medical complications (OR = 0.005, 95%CI 0.002-0.008). Stratification by age showed that the mFI-5 was a stronger risk predictor in younger patients who are frail. Stratification by type of reconstruction showed that increased mFI scores signifi-cantly correlated with complications in both autologous and implant-based reconstruction, but the correlation was greater in autologous procedures.Conclusion: The mFI-5 is identified as a powerful risk predictor in breast reconstruction. The application of this easily accessible tool in the preoperative risk stratification of patients under-going breast reconstruction can enhance treatment planning and support, optimizing patient counseling, informed consent, and decision-making.(c) 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by El-sevier Ltd. All rights reserved.