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Modified Frailty Index Predicts Postoperative Outcomes in Patients Undergoing Radical Pelvic Surgery.
Shannon L McChesney1, Daniel J Canter1, Dominique J Monlezun2
1From the Departments of *Colon and Rectal Surgery, and.
The American Surgeon
|March 14, 2020
Summary
Preoperative frailty assessment using the modified frailty index (MFI) predicts major complications and 30-day mortality in patients undergoing radical pelvic surgery. An MFI score of 3 or higher indicates increased risk.
Area of Science:
- Surgical Oncology
- Geriatric Surgery
- Patient Outcomes Research
Background:
- Radical pelvic surgery, including proctectomy and cystectomy, carries significant risks of postoperative complications.
- Patient frailty is a known vulnerability factor for adverse surgical events.
- Preoperative frailty assessment may offer predictive value for surgical outcomes.
Purpose of the Study:
- To investigate the correlation between preoperative frailty, measured by the modified frailty index (MFI), and the likelihood of severe complications (Clavien-Dindo grade IV) and 30-day mortality.
- To evaluate the MFI as a predictive model for adverse outcomes in patients undergoing proctectomy or radical cystectomy.
- To assess the added predictive value of the American Society of Anesthesiologists (ASA) class to the MFI.
Main Methods:
- Utilized the NSQIP database to identify 10,048 patients who underwent proctectomy or radical cystectomy between 2008 and 2012.
- Calculated preoperative frailty using the 11-point modified frailty index (MFI), categorizing patients into groups with scores <3 and ≥3.
- Analyzed major postoperative morbidities and mortality in relation to MFI scores and ASA class.
Main Results:
- The MFI significantly predicted both 30-day mortality (P < 0.0001) and Clavien-Dindo grade IV complications (P < 0.0001).
- An MFI score of ≥3 was identified as predictive of postoperative morbidity and mortality.
- Incorporating ASA class with the MFI improved the discriminative power for predicting both complications and 30-day mortality.
Conclusions:
- Preoperative frailty assessment using the MFI is a valuable tool for predicting adverse outcomes in patients undergoing radical pelvic surgery.
- An MFI score of 3 or greater reliably indicates an elevated risk for postoperative morbidity and mortality.
- Routine preoperative frailty calculation is recommended to identify high-risk patients and guide clinical management.
