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Using The Modified Frailty Index To Predict Complications In Breast Reduction: An Analysis Of 14,366 Cases
Helen Liu, BS1, Arya A. Akhavan, MD2, Eric Alerte, BS1, Taylor Ibelli, BS, MSc1, Suhas K. Etigunta, BS1, Abigail Katz, BS1, Annet S. Kuruvilla, BS3, Peter J. Taub, MD, FACS, FAAP1.
1Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Johns Hopkins Hospital, Baltimore, MD, USA, 3Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.

PURPOSE: Breast reduction surgery is well-tolerated and has high patient satisfaction, with low risk of surgical site infection and other complications. Breast reduction is among the most commonly performed procedures by plastic surgeons. While age, obesity, and major comorbidities have historically been used as predictors of surgical risk, recent literature now supports frailty measures as a better predictor of surgical risk, such as the modified 5-item frailty index (mFI-5). The authors hypothesized that the mFI-5 is more predictive of 30-day postoperative complications in breast reduction, as compared to other risk proxies.
METHODS: A retrospective review was performed of all patients from the American College of Surgeonsí National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent breast reduction without other concurrent procedures, from 2013 to 2019. The mFI-5 and modified Charlson Comorbidity Index (mCCI) scores were calculated for each patient, and complications data were gathered. Age, BMI, number of major comorbidities, ASA class, smoking status, mFI-5 score, and mCCI score were compared as predictors of all-cause 30-day complications, 30-day surgical site complications of any kind, length of stay, and aggregate Clavien-Dindo complication severity score. Univariate logistic and linear regressions and multivariate logistic regression analyses were performed to evaluate predictive value.
RESULTS: A total of 14,366 patients were analyzed. The overall complication rate was 5.6%. mFI-5 score significantly predicted all-cause complications, surgical site complications and complication severity, along with ASA class, BMI, smoking status, number of major comorbidities, and age (all p < 0.0001) (Table 1). The strongest predictor for 30-day aggregate complications and surgical site complications was ASA class ≥4. The strongest predictor for an overnight stay was number of major comorbidities, followed closely by mFI-5 score, and ASA class, and BMI. mFI-5 was a superior predictor of complications compared to BMI, age, and smoking status. Multivariable logistic regression found frailty and smoking status were significantly associated independent predictors of 30-day aggregate complications.
CONCLUSIONS: The mFI-5 is a significant predictor for complications in breast reduction surgery and more significantly associated with complications than common historic risk proxies. While number of major comorbidities are more strongly associated with negative outcomes than mFI-5, the mFI-5 score is a simpler and more reliable tool that can be easily and quickly calculated during a patient consultation to predict complication risk. Surgeons can use the data in the preoperative evaluation of patients requesting breast reduction surgery. Further research is necessary to better understand the predictive value of mFI-5 for breast reduction surgery complications, and also in the context of specific breast reduction outcomes such as reduction weight, usage of drains, usage of perioperative antibiotics, and nipple necrosis.


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