Effect of Frailty on Postoperative Complications From Colpocleisis

Colpocleisis is an obliterative procedure for pelvic organ prolapse commonly offered to medically complex patients who may not be candidates for reconstructive surgery. Although frailty is a well-established predictor of surgical morbidity, its effect on colpocleisis outcomes is not well defined. The 5-factor Modified Frailty Index (mFI-5) is a validated tool for surgical risk prediction.

This study evaluated the association between mFI-5 and 30-day postoperative complications after colpocleisis.

We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data from 2006 to 2022. We defined frailty as an mFI-5 score ≥2 based on 5 ACS NSQIP-captured items: (1) functional dependence, (2) diabetes, (3) chronic obstructive pulmonary disease, (4) congestive heart failure, and (5) hypertension. Demographic, perioperative variables, and postoperative complications were compared between frail and nonfrail patients. The primary outcome was a composite of any 30-day complication. Secondary outcomes included individual complications, reoperation, and length of stay. Multivariable logistic regression adjusted for prespecified clinical covariates.

Of 5,213 patients undergoing colpocleisis, 93 (1.8%) were frail. Overall, 495 (9.3%) experienced a postoperative complication. More frail patients were Black, had higher body mass index, smoked tobacco, and were assigned American Society of Anesthesiologists classification 3-4. In adjusted models, frailty was independently associated with composite complications (adjusted odds ratio [aOR], 2.04; 95% CI, 1.21-3.48), pneumonia (aOR,15.94; 95% CI, 4.51-56.37), and stroke (aOR, 14.72; 95% CI, 2.74-79.08).

Frailty is an independent predictor of morbidity after colpocleisis with disproportionately elevated risks of pulmonary and cerebrovascular events. Incorporating frailty screening into preoperative evaluation may improve perioperative counseling, stratification, and management.