Assessing Frailty in Plastic Surgery: Analysis of the Five-factor Index.

Area of Science:

• Plastic Surgery
• Geriatric Surgery
• Surgical Outcomes Research

Background:

• Frailty is linked to poor outcomes in many surgical fields.
• Its role in plastic surgery is under investigation with mixed findings.
• The modified frailty index (mFI-5) has not been extensively studied across plastic surgery subspecialties.

Purpose of the Study:

• To evaluate the predictive utility of the modified frailty index (mFI-5) for 30-day morbidity.
• To analyze mFI-5 performance across diverse plastic surgery procedure subcategories.
• To identify specific plastic surgery areas where frailty assessment is most relevant.

Main Methods:

• Utilized data from the 2015-2019 National Surgical Quality Improvement Program (NSQIP).
• Categorized plastic surgery procedures into seven clinical groups.
• Calculated mFI-5 scores and assessed predictive ability for 30-day morbidity using C-statistics and logistic regression.

Main Results:

• Included 188,741 patients; plastic surgery patients exhibited lower mean frailty compared to other specialties.
• mFI-5 demonstrated predictive value for 30-day morbidity in superficial soft tissue procedures (C-statistic: 0.758), hand surgery (0.832), breast reconstruction (0.718), head and neck reconstruction (0.735), and gender surgery (0.732).

Conclusions:

• The modified frailty index (mFI-5) is a valuable clinical tool for risk stratification in select plastic surgery procedures.
• Cautious and selective application of mFI-5 is recommended for soft tissue, hand, head and neck, and breast reconstruction.
• Further research may refine frailty assessment in aesthetic and facial fracture procedures.