Association Of The Modified Frailty Index (mfi-5) With Postoperative Complications After Panniculectomy
Jasmine Lee, BA1, Allyson R. Alfonso1, Rami Kantar2, Gustave K. Diep, MD1, Zoe P. Berman, MD1, Elie P. Ramly, MD1, David A. Daar, MD1, Jamie P. Levine, MD1, Daniel J. Ceradini, MD1.
1NYU Langone Medical Center, New York, NY, USA, 2The University of Maryland Medical System, Baltimore, MD, USA.
Title: Association of the Modified Frailty Index (mFI-5) with Postoperative Complications After Panniculectomy
Authors: Jasmine Lee, BA; Allyson R. Alfonso, BS, BA; Rami S. Kantar, MD, MPH; Gustave K. Diep, MD; Zoe P. Berman, MD; Elie P. Ramly, MD; David A. Daar, MD, MBA; Jamie P. Levine MD; Daniel J. Ceradini, MD
Category: Clinical – Patient Safety Research
Purpose: Due to the high complication rate of panniculectomies, preoperative risk stratification is imperative. This study aimed to assess the predictive value of the 5-item modified frailty index (mFI-5) for postoperative complications following panniculectomy.
Methods: We performed a retrospective review of the ACS-NSQIP database for panniculectomy patients (2010-2015). The mFI-5 score (a composite of diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status) was calculated utilizing a cut-off score of 2. Multivariate logistic and linear regression analysis was conducted to analyze outcomes of wound complication rate, overall complication rate, and length of stay (LOS).
Results: A total of 575 patients were analyzed. Patients with an mFI-5 score of 2 or more (421, 73.2%) had significantly higher BMIs (39.8±10.8 vs. 32.1±8.3; p<0.001), rates of wound complications (19.5% vs. 12.8%; p=0.03), overall complications (33.8% vs. 19.5%; p<0.001), and significantly longer hospital LOS (3.6±5.0 vs. 1.9±3.0 days; p<0.001). MFI-5 score of 2 or more was an independent risk factor for wound complications (OR=1.26; 95% CI: 1.08–2.20; p=0.04) and overall complications (OR=1.34; 95% CI: 1.09–2.15; p=0.02). BMI was an independent risk factor for overall complications (OR=1.05; 95% CI: 1.02–1.08; p<0.001), wound complications (OR=1.05; 95% CI: 1.02–1.08; p<0.001), and longer hospital LOS (β=0.15; 95% CI: 0.11–0.18; p<0.001).
Conclusion: The rising rate of obesity and bariatric surgery has led to an increasing number of medically complex patients requesting panniculectomies. Frailty, as measured by the mFI-5, holds predictive value regarding outcomes of overall and wound complications after panniculectomy. Thus, the mFI-5 can be used preoperatively to identify high risk patients.
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