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Updated: Aug 19, 2025

Author Spotlight: Assessing Surgical Frailty with Point-of-Care Ultrasound of Quadriceps Muscles
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Association Between the Modified Frailty Index and Outcomes Following Lobectomy.

Bryce M Bludevich1, Isabel Emmerick1, Karl Uy1

  • 1Division of Thoracic Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.

The Journal of Surgical Research
|November 28, 2022
PubMed
Summary

Frailty significantly increases postoperative morbidity and mortality in elective lobectomy patients. The abbreviated modified frailty index (mFI-5) effectively identifies these risks, aiding surgical decisions.

Keywords:
Elective thoracic surgeryFrailtyLobectomyPulmonary surgical procedures

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Area of Science:

  • Thoracic Surgery
  • Geriatric Surgery
  • Surgical Outcomes Research

Background:

  • Elective thoracic surgery is considered safe for carefully selected elderly individuals.
  • The impact of frailty on postoperative complications in elective lobectomy patients remains under-researched.
  • This study investigates frailty, using the abbreviated modified frailty index (mFI-5) and mFI-11, in thoracic surgery.

Purpose of the Study:

  • To evaluate the association between frailty and postoperative complications in patients undergoing elective lobectomy.
  • To compare the predictive performance of mFI-5 and mFI-11 in assessing surgical risk.
  • To determine the role of frailty as a predictor of morbidity and mortality.

Main Methods:

  • Analysis of two patient cohorts (2010-2012 and 2013-2019) from the National Surgical Quality Improvement Program (NSQIP) database.
  • Utilized multivariable logistic regression to predict postoperative morbidity, mortality, and major morbidity.
  • Defined patient frailty as modified frailty index (mFI) score ≥3, calculating mFI-5 for all and mFI-11 for the earlier cohort.

Main Results:

  • Postoperative complications were less frequent in the later cohort (2013-2019) compared to the earlier one (17.9% vs. 19.5%).
  • Open lobectomies, more common in 2010-2012, were linked to increased postoperative morbidity and mortality (ORs >1.5).
  • Both mFI-5 and mFI-11 demonstrated significant associations with morbidity and mortality (ORs >1.4) after adjustment; predictive power was similar (C-statistics ~0.61).

Conclusions:

  • Frailty, particularly as assessed by the abbreviated modified frailty index (mFI-5), is a key predictor of postoperative morbidity and mortality after elective lobectomies.
  • Frailty represents a modifiable risk factor that warrants consideration in surgical decision-making.
  • Incorporating frailty assessment into patient counseling can improve perioperative risk communication.