A High Modified Frailty Index Score Correlates with Higher Rates of Postoperative Complications in Free Flap Breast Reconstruction – A Retrospective Analysis on the ACS-NSQIP
Alex Joo, Giorgio Giatsidis
University of Massachusetts Medical School, Worcester, MA
Background: Free flap-based breast reconstruction (FB) improves quality of life in cancer survivors but has a 5-47% higher postoperative complication rate (PC) in vulnerable patients, such as those with obesity or the elderly. Given the rise in these conditions, it is critical to correctly identify patients at higher risk. As prognostic factors, age, BMI (Body Mass Index), and ASA score (American Society of Anesthesiologists) have shown inaccuracies. Since frailty index (mFI) has strong associations with PCs in multiple surgical fields, we hypothesize that it is predictive of PCs and is more predictive than other prognostic factors in FB.
Methods: We used NSQIP data (2010-2018) to identify patients undergoing FB (CPT: 19364). Significance and rates of wound complications, bleeding complications, readmission, return to operating room (OR), and DVT occurrence were compared across mFI, BMI, age, and ASA class.
Results: PCs for mFI ? 2 were 22.22% (p < 0.001) for wound complications; 15.79% (p < 0.001) for bleeding complications; 8.20% (p < 0.001) for readmission; 17.19% (p < 0.001) for return to OR; 1.81% (p < 0.05) for DVTs. Increasing BMI, age, and ASA class did not show significant increases in rates in one or more PCs.
Conclusion: Only mFI showed consistent increases and higher odds of PCs, suggesting frailty is a better predictive factor and should be used preoperatively to counsel surgeons and patients, optimizing surgical management.
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