Related Experiment Video
Updated: May 16, 2026
Identifying Frailty Using Point-of-Care Ultrasonography: Image Acquisition and Assessment
Published on: July 26, 2024
The Modified Frailty Index and Its Association With Esophagectomy Outcomes
Hayley Reddington1, Samih Shafique1, Benjamin Palleiko1
1Division of Thoracic Surgery, Department of Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
Introduction:
Frailty is a progressive loss of vigor, with or without coexisting conditions, accompanied by physical and cognitive decline. The modified Frailty Index (mFI-5) is a comorbidity-based index that has been associated with worse outcomes after some surgeries. This study aims to elucidate whether the mFI-5 could be a predictor of esophagectomy outcomes.
Methods:
Patients undergoing esophagectomy for malignancy were identified using the National Surgical Quality Improvement Program targeted database from 2016 to 2022. Primary outcome was major complication or 30-d mortality (M/M). Descriptive analysis, univariable, and multivariable logistic regression models correlated mFI-5 and other preoperative characteristics with M/M. C-statistics were used to determine the predictive power of the models.
Results:
A total of 5657 patients met the inclusion criteria. In the univariate regression, the mFI-5 score was significantly associated with M/M (P< 0.0001). In the multivariable model with the mFI-5 as a predictor, an mFI-5 of >2 was strongly correlated with postoperative M/M (P= 0.0002). The relationship was maintained whether mFI-5 >2 or each of the individual comorbidities was used in the models. When the individual components of the mFI-5 score were represented separately in the model, all were statistically significant except for dependent status.
Conclusions:
In this cohort of esophagectomy patients, an association between frailty and poor outcomes was identified. Esophagectomy outcomes were more related to the comorbid conditions that make up the mFI-5 score than to the overall score. Future studies should explore other measures of true physiologic frailty.
Insights
The modified Frailty Index (mFI-5) can predict major complications or mortality after esophagectomy. However, individual comorbidities within the mFI-5 are more predictive than the overall score for these adverse outcomes.
Area of Science:
- Surgical oncology
- Geriatric surgery
- Outcomes research
Background:
- Frailty, characterized by diminished physiological reserve, is linked to adverse surgical outcomes.
- The modified Frailty Index (mFI-5) is a comorbidity-based measure associated with poorer results in some surgical settings.
- The predictive value of mFI-5 for esophagectomy outcomes remains to be fully elucidated.
Purpose of the Study:
- To determine if the modified Frailty Index (mFI-5) can predict major complications or 30-day mortality (M/M) after esophagectomy.
- To assess the association between mFI-5 score and postoperative M/M in patients undergoing esophagectomy.
- To compare the predictive power of the overall mFI-5 score versus its individual components for esophagectomy outcomes.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program targeted database (2016-2022).
- Inclusion of patients undergoing esophagectomy for malignancy.
- Utilized descriptive analysis, univariable, and multivariable logistic regression, with C-statistics to evaluate predictive accuracy for M/M.
Main Results:
- A total of 5657 patients were included in the study.
- The mFI-5 score was significantly associated with M/M in univariate analysis (P<0.0001).
- An mFI-5 score >2 strongly correlated with postoperative M/M (P=0.0002) in multivariable models, with individual comorbidities showing significant predictive value, except for dependent status.
Conclusions:
- Frailty, as measured by mFI-5, is associated with poor outcomes in esophagectomy patients.
- Individual comorbid conditions comprising the mFI-5 are more strongly related to esophagectomy outcomes than the overall frailty score.
- Further research is recommended to explore alternative measures of physiological frailty for improved prediction.
Related Concept Videos
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...