Modified Frailty Index and Postoperative Outcomes of Zygomaticomaxillary Complex Fracture Repair

The modified 5-item frailty index (mFI-5) is a comorbidity-based risk stratification tool previously validated in patients undergoing facial plastic and reconstructive surgery. This retrospective US hospital database study investigates the association between mFI-5 score and postoperative complications following zygomaticomaxillary complex (ZMC) fracture repair.

The National Surgical Quality Improvement Program was queried for patients undergoing ZMC fracture repair between 2005 and 2020. The mFI-5 score was calculated by assigning one point for each of the following comorbidities: diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status. Patients were stratified by mFI-5 score. Univariate and multivariable analyses were performed to assess associations between frailty and postoperative complications.

A total of 2260 patients were included and stratified by mFI-5 scores of 0 (n = 1890), 1 (n = 285), and 2 or greater (n = 85). Higher mFI-5 scores were associated with male sex, older age, higher American Society of Anesthesiologists classification, inpatient status, obesity, weight loss, bleeding disorders, and dependent functional status. Higher mFI-5 was associated with increased rates of surgical complications, urinary tract infections, prolonged ventilation over 48 h, pneumonia, cumulative morbidity, and cumulative medical complications. On multivariable analysis, mFI-5 scores of 1 (p = 0.027) and 2 or greater (p = 0.049) were independently associated with cumulative morbidity, and a score of 1 was associated with surgical complications (p = 0.022).

The mFI-5 is associated with cumulative morbidity and surgical complications following ZMC fracture repair. Assessment of frailty may improve perioperative risk stratification in this population.

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