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The Modified 5-Item Frailty Index is a Predictor of Perioperative Complications in Digital Replantation
Thor S Stead1, Neel Vishwanath2, Nikhil Sobti2
1Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, New York City, USA.
Background:
Digit replantation has a significant risk of postoperative complications including an estimated reoperation rate around 14%. This study evaluates the modified frailty index 5 (mFI-5) in predicting postoperative complications including reoperation for digit replantation.
Methods:
The American College of Surgeons' National Surgical Quality Improvement Program database (2007-2019) was queried to identify patients who underwent upper extremity blood vessel repair distal to the wrist. Demographics, patient characteristics, mFI-5 scores, and all complications, including reoperation and readmission, were analyzed using univariate and multivariate analyses to identify associations between mFI-5 and complications.
Results:
We identified 1336 patients who underwent digit replantation. Of those, 99 patients (7.4%) had mFI-5 ≥ 3. Frail patients were defined as having mFI-5 ≥ 3 based on prior literature. Higher mFI-5 scores correlated with increased rates of all-cause complications (mFI-5 ≥ 3: 51.5% vs mFI-5 = 0: 9.2%, P < .001), readmission (mFI-5 ≥ 3: 15.8% vs mFI-5 = 0: 2.2%, P < .001), and reoperation (mFI-5 ≥ 3: 8.8% vs mFI-5 = 0: 3.1%, P < .001). Multivariate analysis indicated that an mFI-5 score ≥ 3 significantly increased the rates of any complication (odds ratio [OR] = 9.1, 95% confidence interval [CI], 3.9-21.2, P < .001), mortality (OR = 5.4, 95% CI, 1.1-27.0, P = .04), surgical complications (OR = 7.5, 95% CI, 2.5-22.9, P < .001), and medical complications (OR = 13.4, 95% CI, 3.9-46.7, P < .001). These patients also had lower odds of home discharge (OR = 0.35, 95% CI, 0.22-0.56, P < .001) and higher odds of unplanned readmission (OR = 1.4, 95% CI, 1.3-1.5, P < .001) compared with those with mFI-5 = 0.
Conclusions:
The mFI-5 is an effective tool for predicting adverse outcomes in digit replantation. It is simple to calculate preoperatively and aids in risk stratification, perioperative counseling, operative planning, and postoperative outcomes.
Insights
The modified frailty index 5 (mFI-5) effectively predicts complications after digit replantation, including reoperation. Higher mFI-5 scores indicate increased risk, aiding in patient counseling and surgical planning.
Area of Science:
- Reconstructive surgery
- Surgical outcomes research
- Patient risk stratification
Background:
- Digit replantation carries a significant risk of postoperative complications, with reoperation rates estimated around 14%.
- Accurate prediction of these complications is crucial for patient management and surgical planning.
- The modified frailty index 5 (mFI-5) is a potential tool for assessing patient risk.
Purpose of the Study:
- To evaluate the efficacy of the modified frailty index 5 (mFI-5) in predicting postoperative complications, including reoperation, following digit replantation.
- To identify associations between mFI-5 scores and adverse outcomes in patients undergoing digit replantation.
Main Methods:
- Utilized the American College of Surgeons' National Surgical Quality Improvement Program database (2007-2019).
- Identified 1336 patients who underwent digit replantation.
- Analyzed demographics, patient characteristics, mFI-5 scores, and complications (reoperation, readmission) using univariate and multivariate analyses.
Main Results:
- Patients with mFI-5 ≥ 3 (frail) had significantly higher rates of all-cause complications (51.5% vs 9.2%), readmission (15.8% vs 2.2%), and reoperation (8.8% vs 3.1%) compared to those with mFI-5 = 0.
- Multivariate analysis showed mFI-5 ≥ 3 significantly increased odds of any complication (OR=9.1), mortality (OR=5.4), surgical complications (OR=7.5), and medical complications (OR=13.4).
- Frail patients had lower odds of home discharge (OR=0.35) and higher odds of unplanned readmission (OR=1.4).
Conclusions:
- The mFI-5 is a simple, effective tool for predicting adverse outcomes in digit replantation.
- Preoperative calculation of mFI-5 aids in risk stratification, patient counseling, and operative planning.
- Utilizing mFI-5 can help optimize perioperative care and improve postoperative outcomes for digit replantation patients.
