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Updated: Sep 25, 2026
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Published on: July 26, 2024
The Modified Frailty Index Predicts Failure-to-Rescue Mortality After Pancreatoduodenectomy: A Comparison of the
Matteo De Pastena1,2, Salvatore Paiella2,3, Simone Veneroni1
1General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
Background:
Frailty may influence outcomes after pancreatoduodenectomy (PD). We compared the prognostic performance of the 11-item modified Frailty Index (mFI-11) and the simplified 5-item version (mFI-5) and explored their link with post-pancreatectomy mortality (PPM).
Methods:
We retrospectively analyzed 1926 adults undergoing PD for periampullary lesions (2015-2023). Frailty was classified as non-frail, mildly frail, or severely frail. Co-primary outcomes were major complications, defined as Clavien-Dindo grade ≥ III, and 90-day mortality. Separate adjusted logistic models were fitted for each index; Firth regression was used for mortality sensitivity analyses. Discrimination was assessed by AUC and compared using DeLong tests. Deaths were independently adjudicated as PPM1, PPM2, or PPM3.
Results:
Major complications occurred in 350 patients (18.2%), and 90-day mortality was 52 (2.7%). Both indices showed a stepwise increase in event rates across frailty strata. In adjusted models, severe frailty was independently associated with mortality (mFI-11: OR 4.1, 95% CI 1.6-10.3, p < 0.001; mFI-5: OR 2.8, 95% CI 1.4-5.6, p = 0.015 by Firth regression). Discrimination was modest and comparable between indices for major complications (AUC 0.629 vs. 0.630; DeLong p = 0.68) and good and comparable for mortality (AUC 0.761 vs. 0.757; DeLong p = 0.48). Severe frailty was independently associated with PPM2 deaths for both indices but not with PPM1 or PPM3, although the latter subgroups were underpowered.
Conclusion:
The mFI-5 performs similarly to the mFI-11 after PD and is preferable for routine use due to its simplicity. Frailty is more strongly linked to mortality, especially pancreas-specific failure-to-rescue trajectories, than to major morbidity alone.
