Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Breast Reconstruction

OBJECTIVE Limited tools exist to stratify perioperative risk in patients undergoing spinal procedures. The modified frailty index (mFI) based on the Canadian Study of Health and Aging Frailty Index (CSHA-FI), constructed from standard demographic variables, has been applied to various other surgical populations for risk stratification. The authors hypothesized that it would be predictive of postoperative morbidity and mortality in patients undergoing spine surgery. METHODS The 2006–2010 National Surgical Quality Improvement Program (NSQIP) data set was accessed for patients undergoing spine surgeries based on Current Procedural Terminology (CPT) codes. Sixteen preoperative clinical NSQIP variables were matched to 11 CSHA-FI variables (changes in daily activities, gastrointestinal problems, respiratory problems, clouding or delirium, hypertension, coronary artery and peripheral vascular disease, congestive heart failure, and so on). The outcomes assessed were 30-day occurrences of adverse events. These were then summarized in groups: any infection, wound-related complication, Clavien IV complications (life-threatening, requiring ICU admission), and mortality. RESULTS A total of 18,294 patients were identified. In 8.1% of patients with an mFI of 0 there was at least one morbid complication, compared with 24.3% of patients with an mFI of ≥ 0.27 (p < 0.001). An mFI of 0 was associated with a mortality rate of 0.1%, compared with 2.3% for an mFI of ≥ 0.27 (p < 0.001). Patients with an mFI of 0 had a 1.7% rate of surgical site infections and a 0.8% rate of Clavien IV complications, whereas patients with an mFI of ≥ 0.27 had rates of 4.1% and 7.1% for surgical site infections and Clavien IV complications, respectively (p < 0.001 for both). Multivariate analysis showed that the preoperative mFI and American Society of Anesthesiologists classification of ≥ III had a significantly increased risk of leading to Clavien IV complications and death. CONCLUSIONS A higher mFI was associated with a higher risk of postoperative morbidity and mortality, providing an additional tool to improve perioperative risk stratification.

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Risk Stratification of Elderly Patients Undergoing Spinal Surgery Using the Modified Frailty Index

Global Spine Journal ◽

10.1177/2192568221999650 ◽

2021 ◽

pp. 219256822199965

Author(s):

Barry Ting Sheen Kweh ◽

Hui Qing Lee ◽

Terence Tan ◽

Kim Siong Tew ◽

Ronald Leong ◽

...

Keyword(s):

Risk Stratification ◽

Elderly Patients ◽

Surgical Site Infection ◽

Spine Surgery ◽

Complication Rate ◽

Frailty Index ◽

Major Complication ◽

Site Infection ◽

Modified Frailty Index ◽

Major Complication Rate

Study Design: Retrospective cohort. Objectives: To validate the 11-item modified Frailty Index (mFI) as a perioperative risk stratification tool in elderly patients undergoing spine surgery. Methods: All consecutive cases of spine surgery in patients aged 65 years or older between July 2016 and June 2018 at a state-wide trauma center were retrospectively reviewed. The primary outcome was post-operative major complication rate (Clavien-Dindo Classification ≥ III). Secondary outcome measures included the rate of all complications, 6-month mortality and surgical site infection. Results: A total of 348 cases were identified. The major complication rate was significantly lower in patients with an mFI of 0 compared to ≥ 0.45 (18.3% versus 42.5%, P = .049). As the mFI increased from 0 to ≥ 0.45 there was a stepwise increase in risk of major complications ( P < .001). Additionally, 6-month mortality rate was considerably lower when the mFI was 0 rather than ≥ 0.27 (4.2% versus 20.4%, P = .007). Multivariate analysis demonstrated an mFI ≥ 0.27 was significantly associated with an increased incidence of major complication (OR 2.80, 95% CI 1.46-5.35, P = .002), all complication (OR 2.93, 95% CI 1.70-15.11, P < .001), 6-month mortality (OR 7.39, 95% CI 2.55-21.43, P < .001) and surgical site infection (OR 4.43, 95% CI 1.71-11.51, P = .002). The American Society of Anesthesiologists’ (ASA) index did not share a stepwise relationship with any outcome. Conclusion: The mFI is significantly associated in a gradated fashion with increased morbidity and mortality. Patients with an mFI ≥ 0.27 are at greater risk of major complications, all-complications, 6-monthy mortality, and surgical site infection.

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Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2018.05.029 ◽

2018 ◽

Vol 43 (8) ◽

pp. 701-709 ◽

Cited By ~ 31

Author(s):

Jacob M. Wilson ◽

Russell E. Holzgrefe ◽

Christopher A. Staley ◽

Mara L. Schenker ◽

Clifton G. Meals

Keyword(s):

Risk Stratification ◽

Surgical Management ◽

Distal Radius ◽

Frailty Index ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Modified Frailty Index

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Spinal Surgery in Patients Aged 80 Years and Older: Risk Stratification Using the Modified Frailty Index

Global Spine Journal ◽

10.1177/2192568220914877 ◽

2020 ◽

pp. 219256822091487

Author(s):

Barry Kweh ◽

Hui Lee ◽

Terence Tan ◽

Tom O’Donohoe ◽

Joseph Mathew ◽

...

Keyword(s):

Risk Stratification ◽

Surgical Site Infection ◽

Spinal Surgery ◽

Frailty Index ◽

Major Complication ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Site Infection ◽

Valuable Adjunct ◽

Modified Frailty Index

Study Design: This was an ambispective clinical quality registry study. Objective: To evaluate utility of 11-variable modified Frailty Index (mFI) in predicting postoperative outcomes among patients ≥80 years undergoing spinal surgery. Methods: Consecutive patients ≥80 years who underwent spinal surgery between January 1, 2013, and June 30, 2018, were included. Primary outcome measure was rate of major complication. Secondary outcome measures were (1) overall complication rate, (2) surgical site infection, and (3) 6-month mortality. Results: A total of 121 operations were performed. Demographic metrics were (1) age (mean ± SD) = 83.1 ± 2.8 years and (2) mFI (mean ± SD) = 2.1 ± 1.4 variables. As mFI increased from 0 to ≥4 variables, risk of major complication increased from 18.2% to 40.0% ( P = .014); overall complication increased from 45.5% to 70.0% ( P = .032); surgical site infection increased from 0.0% to 25.0% ( P = .007). There were no significant changes in risk of 6-month mortality across mFIs ( P = .115). Multivariate analysis showed that a higher mFI score of ≥3 variables was associated with a significantly higher risk of (1) major complication ( P = .025); (2) overall complication ( P = .015); (3) surgical site infection ( P = .007); and (4) mortality ( P = .044). Conclusions: mFI scores of ≥3/11 variables were associated with a higher risk of postoperative morbidity in patients aged ≥80 years undergoing spinal surgery. The mFI-associated risk stratification provides a valuable adjunct in surgical decision making for this rapidly growing subpopulation of patients.

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