Frailty predicts morbidity, complications, and mortality in patients undergoing complex abdominal wall reconstruction

Frailty is becoming an increasingly established risk factor for adverse postoperative outcomes. Given the innately high morbidity involved in complex abdominal wall reconstruction (CAWR) and the propensity for co-morbidities among this patient population, we sought to determine the predictive utility of a frailty index in patients undergoing CAWR.

A retrospective analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database. A total of 70,339 patients undergoing CAWR were identified using CPT codes for ventral hernia repair  ± components separation, ± placement of mesh. A Modified Frailty Index (mFI) was calculated for each patient. Outcomes included overall morbidity, Clavien-Dindo Grade IV (CDIV) complications, and mortality.

Overall, 9931 patients had at least one complication associated with their procedure and an average calculated mFI of 0.12 (± 0.11) which was significantly greater than the average mFI noted in patients with no complications (0.077 ± 0.85, p <  0.001). Similarly, average mFI score (0.16  ±  0.12) in patients with CDIV complications (n = 2541) was once again significantly greater than those without CDIV complications (0.080  ±  0.09; p  <  0.001). Multivariable analyses also showed that all individual factors of the mFI were predictive of all-cause and CDIV complications (p  <  0.001). Higher pre-operative mFI conferred a 7.77×  likelihood of all-cause complications, 35.71×  likelihood of CDIV complications, 3.85×  likelihood of surgical site complications, and a 62.05×  likelihood of death (p  <  0.001 for all comparisons).

We have shown that frailty as measured by mFI is an accurate predictor of morbidity and mortality in patients undergoing CAWR.