Association of frailty with perioperative outcomes after mastectomy with and without immediate breast reconstruction

Frailty has been recognized as an independent risk factor for adverse postoperative outcomes. Coding based frailty instruments such as the Modified Frailty Index (mFI-5) are increasingly incorporated into risk models to provide better prediction of mortality, and complications. However, few have examined the large-scale utility of mFI-5 in the context of mastectomy and breast reconstruction.

All elective adult (≥ 18 years) hospitalizations in women for mastectomy, with and without immediate breast reconstruction (IBR) were identified in the 2016-2022 National Inpatient Sample. Patients with an mFI-5 score ≥ 2 were considered Frail. Multivariable regression models were constructed to evaluate the association of frailty with major complications, length of stay (LOS) and inpatient costs.

Of an estimated 150,215 patients, 14 % were considered Frail. The proportion of frail patients was increased from 13 % to 16 % during the study period. Relative to others, Frail had a greater mean Elixhauser Index (4.49 ± 1.51 vs 1.89 ± 1.29, P < 0.001), was more commonly of Black race (23.7 vs 11.8 %, P < 0.001) and of the lowest income quartile (29.8 vs 17.1 %, P < 0.001).Following comprehensive risk adjustment, frailty was associated with increased odds of infectious (AOR 2.36, CI 1.35-4.13), respiratory (AOR 2.05, CI 1.44-2.92), and renal (AOR 5.62, CI 4.16-7.60) complications. Moreover, frailty was associated with greater length of stay, but no difference in hospitalization costs.

Frailty remains associated with greater postoperative complications and length of stay. Status of frailty as ascertained by the mFI-5 may be useful in stratifying patient risk among those receiving mastectomy.