The 5-factor modified frailty index as a predictor of outcomes in abdominal wall reconstruction

Frailty is a known predictor of adverse postoperative outcomes in certain settings; however, its utility in abdominal wall reconstruction (AWR) is yet to be established. Patients undergoing AWR typically have health complexities and comorbidities. However, few risk stratification tools exist for this patient population. This study evaluated the relevance and predictive value of the 5-factor modified frailty index (mFI-5) for outcomes following AWR.

The American College of Surgeons National Surgical Quality Improvement Program database (2011-2022) was searched to identify adult patients undergoing AWR. Patients were stratified according to the mFI-5 (0, 1, 2, and ≥ 3). The demographic and 30-day complication data, such as reoperation, readmission, and wound complications, were collected. Multivariable logistic regression adjusted for covariates, and marginal effects analysis estimated predicted probabilities for outcomes.

In the 26,856 identified patients, mFI-5 ≥ 3 compared with 0 was independently associated with increased odds of all-cause complications (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.54-2.28, p < 0.001), wound complications (OR 1.49, 95% CI 1.17-1.90, p = 0.001), reoperation (OR 1.43, 95% CI 1.03-1.98, p = 0.031), readmission (OR 1.40, 95% CI 1.09-1.80, p = 0.008), and mortality (OR 3.19, 95% CI 1.56-6.52, p = 0.002). Predicted probabilities of complications increased from 15.1% (mFI-5 = 0) to 25.0% (mFI-5 ≥ 3), and almost 50% of the patients in the most-frail cohort were discharged to a non-home setting.

The mFI-5 is associated with increased risk of adverse outcomes in AWR, with higher frailty scores linked to elevated rates of significant postoperative complications. Incorporating frailty assessments into preoperative workflows may improve patient counseling and risk stratification.