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Frailty Indices Outperform Historic Risk Proxies as Predictors of Postabdominoplasty Complications: An Analysis of a
Arya A Akhavan1, Helen Liu2, Eric Alerte2
1From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
Background:
Although age, body mass index (BMI), and major comorbidities were historically used as predictors of surgical risk, recent literature supports patient frailty as a more accurate predictor. Database studies and chart reviews support the modified Charlson Comorbidity Index (mCCI) and the Modified Five-Item Frailty Index (mFI-5) as predictors of postsurgical complications in plastic surgery. The authors hypothesized that the mFI-5 and mCCI are more predictive of abdominoplasty complications than historic risk proxies.
Methods:
A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database was performed for abdominoplasty patients from 2013 to 2019. Demographics, comorbidities, and complications were gathered. The mFI-5 and mCCI scores were calculated per patient. Age, BMI, major comorbidities, American Society of Anesthesiologists class, mFI-5 score, and mCCI score were compared as predictors of all-cause 30-day complications, 30-day surgical-site complications, length of stay, and aggregate Clavien-Dindo complication severity score.
Results:
Of 421 patients, the strongest predictors for all-cause complications and complication severity were mCCI score greater than or equal to 3 and mFI-5 score greater than or equal to 2. The mFI-5 score was the strongest predictor of unplanned reoperation. Length of stay was best predicted by age greater than or equal to 65. The only predictor of surgical-site complications was BMI greater than or equal to 30.0 kg/m 2 . Smoking was predictive of complication severity, but not any other outcome.
Conclusions:
The mFI-5 and mCCI are stronger outcome predictors than historically used factors, which showed little predictive value in this cohort. Although the mCCI is a stronger predictor than the mFI-5, the mFI-5 is easily calculated during an initial consultation. Surgeons can apply these tools to aid in risk stratification for abdominoplasty.
Clinical Question/Level Of Evidence:
Risk, III.
Insights
Patient frailty, measured by the Modified Five-Item Frailty Index (mFI-5) and the modified Charlson Comorbidity Index (mCCI), better predicts abdominoplasty complications than traditional risk factors. These indices aid surgeons in surgical risk stratification.
Area of Science:
- Plastic Surgery
- Surgical Outcomes
- Patient Risk Stratification
Background:
- Traditional predictors of surgical risk include age, BMI, and comorbidities.
- Patient frailty is emerging as a more accurate predictor of postsurgical complications.
- The modified Charlson Comorbidity Index (mCCI) and Modified Five-Item Frailty Index (mFI-5) are validated tools for assessing surgical risk.
Purpose of the Study:
- To compare the predictive value of the mFI-5 and mCCI against traditional risk factors for abdominoplasty complications.
- To determine the most effective tools for risk stratification in abdominoplasty patients.
Main Methods:
- Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database (2013-2019).
- Analysis of 421 abdominoplasty patients, calculating mFI-5 and mCCI scores.
- Comparison of age, BMI, comorbidities, ASA class, mFI-5, and mCCI as predictors for various outcomes.
Main Results:
- mCCI (≥3) and mFI-5 (≥2) were the strongest predictors of all-cause complications and severity.
- mFI-5 was the strongest predictor of unplanned reoperation.
- BMI (≥30.0 kg/m²) was the sole predictor of surgical-site complications; age (≥65) predicted length of stay.
Conclusions:
- The mFI-5 and mCCI demonstrate superior predictive value for abdominoplasty outcomes compared to historical factors.
- While mCCI is a stronger predictor, mFI-5 is easily calculable during consultations.
- These frailty indices can significantly aid surgeons in risk stratification for abdominoplasty procedures.
