A Comparison of Preoperative Frailty Indices Correlation With Perioperative Risk for Patients Undergoing...

To assess whether frailty as defined by the NSQIP mFI-5 or the RAI-rev indices is correlated with 30-day postoperative outcomes for patients undergoing sacrocolpopexy (SCP), and whether one index is more closely correlated than the other.

SCPs performed between 2006-2020 were identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. Frailty was calculated using two indices: the NSQIP modified frailty index (mFI-5), and the revised surgical Risk Analysis Index (RAI-rev). mFI-5 scores and RAI-rev scores were analyzed as continuous variables. Binary logistic regression and t test analyses were performed to apply mFI-5 and RAI-rev as predictors of surgical complications, 30-day readmissions, 30-day mortality, and hospital length of stay.

We identified 9082 SCPs between 2006-2020. Minor complications were experienced by 5.2% of patients, and 3.9% of patients experienced major complications. The 30-day readmission and mortality rates were 2.8% and 0.02%, respectively. The mFI-5 was significantly associated with increased odds of major complications overall, failure to wean ventilator, myocardial infarction, septic shock, and 30-day readmission. The RAI-rev, on the other hand, was associated with increased odds of individual complications such as pneumonia, failure to wean ventilator, renal failure, cerbral vascular accident, cardiac arrest, myocardial infarction, and septic shock.

Frailty may be a useful predictor of complications after SCP, depending on which frailty index is used. The mFI-5 is significantly associated with increased odds of major complications and 30-day readmission, and may help in the decision making and risk counseling for patients with pelvic organ prolapse considering SCP.